You are a psychologist in a busy acute care hospital where you receive frequent consultation requests by the trauma service. A physician requests a psychological evaluation of a 46-year-old man who attempted suicide via over dose of prescription medications along with alcohol. You arrive in the intensive care unit where the patient’s respiratory status is rapidly deteriorating. He is marginally coherent and unable to give any consistent responses. However, upon his arrival in the emergency department, the medical record quotes the patient as saying, “This wasn’t supposed to have happened.”
The ICU nurse asks you to offer an opinion regarding the patient’s capacity to accept or refuse intubation.
While you are there, a family member arrives with a copy of a notarized advance directive, created within the last year, which specifically outlines the patient’s wishes not to be placed on a ventilator or any artificial life support. The ICU staff asks for your input.
What are the ethical issues involved?
What would you do in this situation?
Would your answer differ if the advanced directive was created 7 years ago or greater?
Would your answer differ if there were no advanced directives?