George Stein is a 73 year old man with type 2 diabetes, a history of two heart attacks and multiple strokes. Subsequent to the strokes, he developed multi-infarct dementia. He is in a skilled nursing facility where he was placed by his wife four years ago.
Mr. Stein has a colostomy and a urine drainage tube, as well as decubitus ulcers which require frequent dressing changes and cause significant pain. He is not ambulatory, speaks only a few words and requires assistance with all ADLs. His prognosis overall is poor. Mr. Stein has now developed pneumonia.
Dr. Miles, his primary care physician, visited him at the skilled nursing facility. Dr. Miles believes that Mr. Stein can recover from the pneumonia if he receives a course of antibiotics. However, she believes he is unlikely to return to his prior baseline, which was already a poor quality of health. She explained the treatment options and likely outcomes to Mrs. Stein. After a detailed discussion, they agreed not to give antibiotics.
Mrs. Stein understands that withholding antibiotics may hasten Mr. Stein's death. She believes, however, that if her husband could understand his condition and could communicate, he would choose to forgo antibiotics and allow a natural death given his poor quality of life and poor overall prognosis.
Dr. Miles documented the decision not to give antibiotics in Mr. Stein's record and promised to follow up in the next few days to see how he is doing.
© 2016 University of Washington | School of Nursing | L&IT Learning Technologies | Palliative Care Training Center | National Institute of Nursing Research (NINR) at the National Institutes of Health (NIH), 1R21NR010896-02A2.
