An 83-year-old diabetic male, Mr. Jones, is brought in to the emergency department because of respiratory distress by his care-giving daughter, with whom he lives. In examining him, the emergency department physician discovers that Mr. Jones has gangrene on his right foot up to his ankle.
Mr. Jones’ daughter reports that her father has been diagnosed with Alzheimer’s disease. A preliminary capacity assessment is consistent with mild dementia, but one of the nurses suggests that Mr. Jones’ confusion might be the result of his respiratory distress, coupled with the disorienting atmosphere of the emergency department.
The clinical recommendation is to perform a below-the-knee amputation. The patient refuses this surgery, saying he has lived long enough and wants to die with his body intact. His daughter disagrees and says she wants everything done so that she can take him home as soon as possible, and says that she will sue the hospital if they do not perform the amputation. A social worker comments that the daughter might be afraid of an elder-neglect investigation if her father dies.
Mr. Jones does not have an advance directive of any kind and is not under guardianship. Assume that the applicable law in your state is the same as Sections 5, 7, and 11 of the Uniform Health-Care Decisions
Answer the following questions with regard to this case:
?cWhat are the relevant legal issues at stake? What are the legal rights of the patient and his daughter?
?cWhat are the relevant ethical issues at stake?
?cWhy does capacity assessment matter?