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Friday, May 29, 2015

Vignette 31: The Near Death of a Salesman

Dr. Miller is a psychologist who consults with local nursing homes and hospitals when a patient’s capacity to make medical decisions is in question.  Dr. Miller receives an urgent call from an attorney to evaluate Willie Loman at a local trauma unit.  The attorney explains that Mr. Loman is looking for an objective opinion about his ability to make medical decisions.

Mr. Loman is a 52-year-old male with a wife and two kids (both in college).  He works as a financially successful salesman.  Over the previous weekend, Mr. Loman was involved in a serious boating accident.  He did not experience any head trauma; however, his physical situation is dire.  The trauma team needs his consent to perform a lifesaving surgery.  If successful, Mr. Loman can live many years.  However, there is a high probability that he will require full-time nursing care. 

Mr. Loman has been active man who enjoyed many physical activities.  Furthermore, he believes if he has the surgery and ends up confined to lifetime nursing care, he will exhaust all the funds he has saved for the benefit of his family.  Mr. Loman believes he will be an emotional burden to his family and lose his dignity.  Knowing that he will be physically compromised and a burden on his family, Mr. Loman is asking to die in peace.  He does not want to live in an incapacitated state of existence.

Without the surgery, Mr. Loman can be kept alive for about two weeks.  The family filed an emergency petition to obtain guardianship.  The trauma team believes that the patient is not thinking clearly about his demise.  They have already called in their psychiatrist-consultant.

Upon examination, Dr. Miller finds Mr. Loman’s mental status is within normal limits.  He demonstrates appropriate memory capabilities and reasoning skills.  He articulates his dilemma well and understands that he will die without surgery.  There is no evidence of hallucinations, delusions, or psychotic processes.

In order to clarify his thinking, Dr. Miller calls you to review this case.

What are competing ethical principles?

How would you feel if you were Dr. Miller?

What are the possible consequences of concluding Mr. Loman is competent and capable of making this decision?

What are the possible consequences of concluding Mr. Loman is not competent and incapable of making this decision?

How do your own professional, personal, and moral values influence how you would participate as a consultant to Dr. Miller?

Does Mr. Loman's age factor into this decision?  In other words, would you make a different decision if Mr. Loman were 72 as compared to 52?