Ethics Vignette X: Oral Advance Directives-Oral Advance Directives

Oral Advance Directives

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The document explores a medical ethics vignette concerning a 56-year-old man with frontotemporal lobar dementia and ALS who is severely cognitively impaired. Despite verbal wishes against extraordinary measures, no advance directives were written. The ethical dilemmas include enforcing verbal directives, the role of the wife in decision-making without proper designation, and conflicting interests between family members. The guidelines discuss the legal status of oral directives and issues with surrogate decision-making, emphasizing the importance of trustworthiness and informed preferences in advance directives. Recommendations for resolving the dilemma include family meetings, explaining perspectives, offering hospice care, and involving hospital resources like chaplains and ethics committees. The vignette concludes with a peaceful resolution through hospice care following family discussions. Suggestions for further reading on surrogate decision-making and shared decision-making in medical ethics are provided. Overall, it illustrates the complexity of navigating ethical dilemmas in clinical practice, emphasizing the importance of understanding patient preferences, effective communication, and collaborative decision-making to provide compassionate end-of-life care.

Keywords

medical ethics

frontotemporal lobar dementia

ALS

cognitive impairment

advance directives

verbal wishes

surrogate decision-making

family meetings

hospice care

end-of-life care

amyotrophic lateral sclerosis