Ethics Roundtable: Advance Directives, Autonomy, and Gastrostomy Placement

Area of Science:

• Geriatric Medicine
• Bioethics
• Palliative Care

Background:

• A 94-year-old male with a history of stroke and frailty presented with new weakness and altered mental status.
• The patient had previously and consistently refused nutritional support, expressing a desire to forgo life-sustaining treatment.

Observation:

• Despite prior refusals, the patient's family, including his designated surrogate, requested a percutaneous endoscopic gastrostomy (PEG) tube.
• The surgical team assessed the patient as lacking capacity and proceeded with scheduling the PEG tube placement.

Findings:

• A conflict arose between the patient's stated wishes for end-of-life care and his family's request for aggressive medical intervention.
• The medical team initiated an ethics consultation to navigate this complex ethical dilemma.

Implications:

• This case highlights the challenges in respecting patient autonomy when capacity is diminished and family wishes diverge.
• It underscores the importance of advance care planning and the role of ethics consultations in resolving conflicts at the end of life.