by Linda Edgeton

Nursing

An elderly man is transferred to the intensive care unit with a diagnosis of chronic obstructive pulmonary disease (COPD). The patient's lung status is assessed on admission by the registered nurse and the pulmonalogist (lung doctor). During the night, the patient required intubation ( a tube placed in the mouth that goes into the lungs) and is placed on mechanical ventilation (machine which breathes for the patient). During the next several weeks, the patient's condition deteriorates and the patient becomes dependant on the ventilator.

The patient communicates to the nurses that he wants to be taken off the ventilator and left to die. However, upon admission to the hospital, the patient signed a living will stating that he wanted to be kept alive. Now he is unable to speak because of the tube in his throat, but he is communicating that he wants life support withdrawn.

Questions:

Does the patient have the right to change his mind?

Does he really understand that he will die if the ventilation support is removed?

What should the nurses do? Legally? Ethically?

Are living wills valid?