Case Study: Advance Care Directive
Kevin is an 88-year-old gentleman from Sydney and suffers from coronary heart disease and Parkinson’s disease. Over the past 2 years his condition has progressively deteriorated. He is very forgetful, and his mobility has decreased significantly. He can’t make financial decisions, and is finding it harder to make minor decisions too. His GP says his Parkinson’s disease is entering its later stages, and he is showing symptoms of dementia.
Until now, Kevin’s wife Mary has cared for Kevin at home, with occasional help from their daughter Helen. Mary is about to have a significant operation and can no longer cope with caring for Kevin. Reluctantly they decide the best option is for Kevin to move to the Hilltop Grove residential aged care facility.
By the time Kevin moves to Hilltop Grove he no longer has capacity for health care decisions, but can make some minor decisions about daily life, such as what food to eat. Mary gives the Nurse Manager a copy of Kevin’s Advance Care Directive, made with their GP a few years earlier, which refuses life-sustaining treatment should he no longer have decision-making capacity. The Directive specifically mentions not wanting antibiotics.
Two months after moving to Hilltop Grove, Kevin contracts pneumonia and is taken by ambulance to the local hospital’s emergency department. He is seriously ill and cannot communicate. He doesn’t appear to understand what Elizabeth, the consulting specialist, is saying. He cannot tell her his name or answer any questions about how he is feeling. Elizabeth sees Kevin’s Advance Care Directive and determines that no antibiotics should be given to Kevin to treat the pneumonia, in accordance with Kevin’s refusal of this treatment. Elizabeth instructs the nurse to only give Kevin medication for pain and symptom relief.
Mary is immobile following her operation, so Helen goes to the hospital alone. On arriving at the hospital Helen is distressed when she learns that antibiotics have not been given to her father. Elizabeth explains to her that she is following the directions in Kevin’s Advance Care Directive. Helen was unaware of Kevin’s Directive, and becomes more distraught. She refuses to leave Kevin’s beside.
Kevin dies the next day. Helen demands to speak with the hospital administration about Kevin’s treatment. At a conference with Elizabeth and the hospital’s lawyer, she accuses Elizabeth of causing Kevin’s death.
The hospital lawyer explains that it was lawful for Elizabeth not to administer antibiotics. Kevin had a valid Advance Care Directive, made voluntarily when he had capacity, which specifically refused this treatment. Elizabeth respected Kevin’s wishes by not providing life-sustaining treatment and relied on a lawful refusal of treatment in the Advance Care Directive.