Jeremy suffered a stroke
Jeremy suffered a stroke and has been readmitted to the hospital. He cannot swallow food and fluids, so the hospital is considering other ways of feeding him. A nasogastric tube has been passed, and the hospital staff is considering inserting a PEG. His son is supporting this decision. However, Jeremy indicates through signals that he wants to feed orally.
Using the PEG creates an ethical dilemma because Jeremy had written an advanced decision ten years ago, indicating that he did not want any unnecessary interventions in case he became a “cabbage.” The autonomy of a patient should be respected. Using a PEG would be going against the autonomy and informed consent of Jeremy.
Given that this relates to Jeremy, it would be appropriate to consider Jeremy’s decision. According to the Human Rights ACT 1998 Article 2, everyone has a Right to Life (Human Rights Commission). Therefore, the hospital administration must protect Jeremy’s life by using a PEG to promote safe feeding. The Mental Health Act, 2005, protects those who have limited capacity to make decisions and provides avenues for them to make as many decisions as they can autonomously (Johnston & Liddle). The Act states that in helping to make decisions for incapacitated persons, the best interests for the person should be prioritized. In determining best interests, the past and presents the wishes of the person must be considered (Johnston & Liddle). However, these interests should be weighed against the best clinical opinions. Jeremy’s consent should be sought if he has the capacity to communicate. According to the case, he wants to be fed orally and not via the tubes. Using the PEG will be going against his consent.
The beneficence principle could be used to solve this dilemma. Beneficence is doing good to others (Kinsinger). Health professionals must do that which is good and morally right for the patient, minimizing harm, and promoting life. In this case, using a PEG would be a good decision as compared to not using it, consequently harming Jeremy. HRA (1998) states that everyone has a Right to Life; using PEG will preserve Jeremy’s life. HRA (1998), Article 2 will help resolve the ethical dilemma, too; right to life should not be violated under any circumstances. Under the Mental Health Act 2005, best interests should be considered with references to the clinical opinion given that Jeremy’s autonomy goes against the HRA 1998. Therefore, using s PEG would be in the best interests of Jeremy.
This is a grey area, but given the ethical and legal considerations, a PEG should be inserted. According to the NMC (2018) Code, health professionals should act in the best interests of their patients at all times. This includes respecting the person’s right to refuse treatment. However, autonomy should not override the preservation of life and act with the best available evidence. In Jeremy’s case, the best available evidence indicated that a PEG would save his life despite his initial decision ten years ago; therefore, a PEG should be used in line with best interests, beneficence, and HRA (1998), Article 2.
Works cited
Johnston, Carolyn, and Jane Liddle. “The Mental Capacity Act 2005: a new framework for
healthcare decision making.” Journal of medical ethics vol. 33,2 (2007): 94-7. doi:10.1136/jme.2006.016972
Kinsinger, Frank Stuart. “Beneficence and the professional’s moral imperative.” Journal of
chiropractic humanities vol. 16,1 (2009): 44-6. doi:10.1016/j.echu.2010.02.006
Human Rights Commission. Article 2: Right to Life
https://www.equalityhumanrights.com/en/human-rights-act/article-2-right-life
Nursing & Midwifery Council. The Code (2018)