CASE STUDY #3 JUSTICE & FUTILITY

1. CASE STUDY #3JUSTICE & FUTILITY Tena Alonzo, MA M. Zuhdi Jasser, MDKelly Shepard, M.Div.

2. CASE #3 • EF, 95 yo male resident of long-term care facility for 3½ years; has moderate-severe dementia • Dependent in all Instrumental Activities of Daily Living (IADLs) • Dependent in most Activities of Daily Living (ADLs) • Wheelchair-bound • Mini-Mental Status Exam 8/30 (normal at least 24) • Does have court-assigned public fiduciary

3. CASE #3 (cont.) Presents to emergency room with recurrent shortness of breath and cough Workup demonstrates heart failure exacerbation with possible overlying pneumonia Emergency department physician recommends hospitalization This is EF’s 4th admission in the past 3 months for essentially the same condition

4. CASE #3 (cont.) No advance directives or living will is available When asked what he wants, EF replies, “I want to feel better.”

5. CASE 3 – QUESTION #1 EF has decision-making capacity for hospitalization • TRUE • FALSE

6. CASE 3 – QUESTION #2 In the absence of advance directives, EF must be hospitalized • TRUE • FALSE

7. CASE 3 – QUESTION #3 Bioethical concerns must be reviewed from the perspective of: • Long-term care facility staff • Payor source • Patient • Physician • Public fiduciary

8. CASE 3 – QUESTION #4 The hospitalist can refuse admission based on an argument of futility • TRUE • FALSE

9. CASE 3 – QUESTION #5 If admitted to the hospital, EF is likely to be discharged to: • His original long-term care facility • A new long-term care facility for sub-acute/rehabilitative care • An acute rehabilitation hospital • He will never be discharged because he will never be medically stabilized