A family fights over continuing their mother’s care. A mother of four children entered the hospital after suffering a massive stroke and was put on a ventilator. Doctors believed that she would not regain brain function. One of her sons got to the hospital first and told doctors that should his mother suffer heart failure or any other irreversible complication, no measures should be taken to save her life. Doctors worked under that assumption until one of the woman’s daughters arrived and claimed that her brother wasn’t interested in helping their mother. He had pushed to put their mother in a nursing home, the sister said, and added that she wanted to do everything possible to extend her mother’s life. The mother was widowed and hadn’t specified which of her children was to make decisions on her behalf. Doctors had to choose whose wishes to follow. The Issues: Without a spouse involved, the responsibility for end- of-life decisions falls on a patient’s children, and without a designated health-care proxy in place, all the children hold equal weight. In cases like this, doctors have to focus on what the patient, not her children, would want, says Nancy Dubler of Montefiore. That means looking for examples of “substituted judgment,” or statements that the patient may have made that give clues about her wishes.
Who has the right to make the decision for end of life in this case?