Prior to admission, Mrs. W. lived at home and received help from a home health aide a few hours a day to assist with washing, meals and light housework. Her physical condition had been failing over the past few years and two years ago her kidneys failed, requiring her to start receiving hemodialysis. These dialysis treatments required her to be taken by ambulette to a center, three times a week, for apporximately five hours per visit. She endured this process fairly well and only occasionally complained to dialysis nurses and neighbors that she was weary of her chronic condition. All of her three grown children live out of state, and according to Mrs. W., have occasional telephone contact andd visits due to the responsibilities of their own.
When Mrs. W. became afflicted with the stroke, her home health aide called the ambulance, and Mrs. W. was rushed to the hospital. The ER staff were able to contact Mrs. W.'s eldest son in North Carolina to notify him of his mother's grave condition. It was explained to the son that Mrs. W. had what appeared to be a massive stroke and would require a tube to be inserted into her airway- so that she could be placed on a ventilator to assist in breathing. The ER physician questioned Mrs. W.'s son as to whether he had any knowledge what his mother's wishes were regarding CPR or life support. The son stated that he did not know what his mother's wishes were and gave approval to the physician to "do whatever you have to." Mrs. W. was then placed on a ventilator and sent to the I.C.U.
It has now been twleve days since Mrs. W.'s admission. She remains unresponsive to all stimuli, verbal and physical. Various tests have been performed to determine the amount of damage the stroke has caused Mrs. W.'s brain. The tests conclude Mrs. W. has suffered a massive stoke that has affected the areas of the brain responsible for cognitive and motor functioning. The brain stem, which allows for an occasion spontaneous breathing response in Mrs. W.'s case, remains intact.
The family is contacted by the hospital to receive consents for procedures necessary to provide further care for Mrs.W., otherwise they do not call or visit. The I.C.U. staff caring for Mrs. W. are saddened by her seemingly hopeless condition. They feel due to the lack of quality of life and dignity that it might have been more humane to have not placed her on life support. The dialysis nurse, who knows Mrs. W. from the center, also cares for her dialylsis needs at the hospital. The dialysis nurse states that Mrs. W. verbalized tha she did not want extraordinary life saving measures, or in Mrs. W.'s words, "When it's time for God to take me, I just want to go peacefully."
The staff begins to confront Mrs. W.'s doctors with this secondhand information regarding the patient's wishes. The doctors agree that Mrs. W.'s treatment is futile and that the situation is a sad one, but state once the family has consented to life support, "it is out of our hands." Two days later, dialysis treatments for Mrs. W. continue and a tracheostomy tube is inserted surgically for long term care and maintenance. No neurological improvement is seen or is expected.
If you are on nursing staff assigned to Mrs. W. what ought you do now?