A 67-year-old wornan is diagnosed with breast cancer. She is fully alert and very specifically both verbally arcl in writing tells you that she does not want to have surgety on her breast to remove the tumor, She fully understands her condition and treatment options. This is a decision her husband and son both disagree with. Over the next several weeks thc patient becomes confused and loses the capacity to understand the details of her medical carc. The hr’rsband and son now approach you to perform the surgery.
which of the following is most approPriate?
a. Refuse to do surgery and follow the original advancc directive.
b. Perform the surgery only if the requcst is in writing.
c. Honor the family’s request and perform the surgery.
d. Consult the ethics committee.
e. Ask the family to seek a court order.
f. Perform the surgery only if you really belieYe that it will benefit the patient in the long term,
Explanation:
(a) Refuse to do surgery and follow the original advance directive,
The patient in this question gave a clear advance directive while she still had deci sion-making capacity. This must be follorved. This case is especially clear because it states there is both a clear verbal as well as written advance directive. Cases in which there is no clear advance directive are much harder, It does not matter if the family’s request is in writing. The case would be considered too straightfbrward to warrant the intervention of an ethics committee. Even if the ethics committee for some reason recommended the surgery, you would still have to refuse because your duty is to follow the patient’s wishes, no one else’s. You cannot refuse a decision made while competent simply because the patient later becomes incompetent. .[f this were not so, then all wills would be invalid. A person’s will is a form of advance directive for their property after they become unable to speak for themselves directly