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ATTACHMENT PREVIEW Download attachmentScenario SummaryPlease Just Turn This Thing Off!A nursing assistant wheels Margie Whitson back to her room at Golden OaksRehabilitation Center and helps her back into bed. Golden Oaks is located on thegrounds of Marion General Hospital, owned and operated by the hospital board ofdirectors.It has been a very difficult day. Margie takes a deep sigh as she leans back into bed andsays, “I’ll get into night clothes in a few minutes if that’s alright. I’d just like to sit hereand think for a little while.” The nursing assistant nods in agreementMargie has just attended the funeral of her son William, who died this week after severalyears of poor life quality in the same nursing facility. William’s first stroke happened 3years prior; two more strokes followed, and he lingered in poor health at the center overthe intervening time. Margie is now 95 years of age, and William was 73 when hepassed this week.The last 5 years have simply been devastating for Margie. First her husband Earlpassed on at the age of 88. They had been married for 68 years, most of themwonderful and successful years together, until the medical problems began. They hadone other son, Jacob, who died in a motor vehicle accident in his 30s.As Margie sits in the quiet of her nursing home room, she faces the reality that she isutterly and completely alone in the world. She and Earl had hoped for grandchildren, butthat never happened, and Margie’s family is simply all gone now. Margie’s own health ispoor. A hip fracture 10 years ago slowed her down significantly, and a heart attack 2years ago nearly took her life. But she survived due to good emergency medical careand quick placement of an electronic pacemaker. Margie’s heart rhythm is now 100%paced, meaning that her heart will not function effectively without the pacemaker; she iscompletely dependent on the pacemaker for her survival.Margie is a woman of great personal faith, raised that way, and she raised her sons thatway. She believes strongly that Earl, William, and Jacob are waiting for her in heaven.And as she sits alone in her nursing home room, the realization comes to her—the onlything keeping her from joining her family in heaven is this pacemaker. And thepacemaker is nothing more than an electrical device. It was turned on to save her life 2years ago, and now it can be turned off. She should have the right to turn it off! Margiepresses the nurse call button and says, “I need to see that lady who’s in charge of thisplace, and right now please.”When Nursing Home Administrator Cindy Mackin enters the room and listens to Margie,she can hardly believe what she is hearing. “I’m telling you I just want you to turn it off.I’ve had enough; there is nothing left for me here on earth and I just need to go now andbe with my family.” Cindy responds, “Now, Margie, you’ve had a terrible time lately, andnaturally you are grieving the loss of your son right now. Things will look bettertomorrow.” But Margie does not think so. She says, “Call Dr. Vijay for me; he turned thisthing on, and he can turn it off. I insist.”
View the AnswerCindy realizes that Margie does have a right to discuss this or any other matter with herdoctor, and she arranges a visit for the following week. At the cardiology clinic, Margie isincreasingly insistent about her demand to deactivate the pacemaker. Dr. Vijaycomments, “Margie, I’ve practiced cardiology for nearly 20 years now, and frankly I havenever had this request. The pacemaker is keeping you alive, and that is of course whatwe do in medicine—we save lives. I do not feel that I can ethically deactivate yourpacemaker. I know that you have had some very difficult experiences lately, andperhaps you will feel differently with a little time passing.”Returning to Golden Oaks, Margie is absolutely fuming, and now she is determined.The same determination that carried her through life and made her such a great wifeand mother is now rising in her to make her own decision about how and when to endher own life. She asks to see the Golden Oaks social worker, and Jane Robison, MSW,is summoned. After more than an hour of discussion and exploration of every option thatJane can imagine, Margie persists in her request. “Well, Margie, we do actually have aprocess to help in difficult situations like this, when patients, families, and doctorsdisagree, through the hospital ethics committee, and I think that we should take yourcase there for review. I happen to know that the ethics committee meets next Friday,and the chairman is a colleague of mine who is our director of social services.”Your AssignmentYou are David Jamison, MHA, ethics committee chairman at Marion General Hospital.Coming before your committee today is the case of Margie Whitson, age 95, whowishes to have her pacemaker deactivated. Her physician, Dr. Rana Vijay, has declinedto honor her request in this matter, citing ethical concerns with such an action. It will beyour job to thoroughly analyze the issues in this case and to make a recommendationfrom the ethics committee.Key PlayersYou DecideActivity or AssignmentMargie WhitsonPatient, FemaleRana Vijay, MDCardiologist, MaleJane Robison, MSWSocial Worker, FemaleCindy Mackin, CNHARehabilitation CenterAdministrator, FemaleDavid Jamison, MHA (This is your role.)Ethics CommitteeChairman, Male
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