Present clinical situation that led to Ethics Team consult with the following scenario: Elderly 85 year old disoriented male patient with end stage lung cancer, is septic, has low blood pressure only maintained by pressers for an extended period of time, and family insisted on intensive care. The patient full code, and still undergoing invasive procedure. 2 pages

Title: Ethical Considerations in the Management of an Elderly Patient with End-Stage Lung Cancer

Introduction:
This paper discusses a clinical situation that led to an Ethics Team consult, involving an 85-year-old disoriented male patient with end-stage lung cancer. The patient is septic, experiencing low blood pressure that is only maintained by pressors for an extended period. Despite the patient’s critical condition, the family insists on intensive care, and the patient is coded as full code, undergoing invasive procedures. This complex case presents several ethical considerations that warrant analysis and discussion.

Background:
End-stage lung cancer is a debilitating condition often associated with poor prognosis and limited treatment options. Elderly patients with advanced cancer pose unique challenges due to age-related physiological changes, increased comorbidity burden, and diminished resilience. Ethical decision-making becomes particularly complex when managing advanced diseases like end-stage lung cancer.

Case Presentation:
In this case, the patient is an 85-year-old male with end-stage lung cancer. He is disoriented and currently experiencing sepsis, resulting in low blood pressure. To maintain his blood pressure, the patient requires pressors. The family insists on intensive care, and the patient’s code status is designated as full code, indicating that all resuscitative measures will be taken in case of a cardiac or respiratory arrest. Despite the patient’s dismal prognosis, invasive procedures are being conducted.

Ethical Considerations:
Several ethical dilemmas arise in this scenario that warrant an Ethics Team consult:

1. Autonomy:
The principle of autonomy dictates that patients have the right to make decisions about their medical treatment based on informed consent. However, in this case, the patient’s mental status is compromised due to disorientation. It is uncertain whether the patient was capable of providing informed consent or even fully understanding the nature and implications of his treatment options. The Ethics Team may need to explore whether the patient has a previously documented advanced directive or appointed healthcare proxy to make decisions on his behalf.

2. Beneficence:
The principle of beneficence emphasizes promoting the well-being of patients and acting in their best interests. In this case, the aggressive management of the patient’s sepsis and maintenance of blood pressure through pressors can be seen as medical interventions aiming to preserve life. However, determining the overall benefit of these interventions in the face of a dismal prognosis and potential burdens on the patient requires careful consideration. The Ethics Team should establish whether the current interventions align with the patient’s values and overall goals of care.

3. Non-Maleficence:
Non-maleficence, the obligation to do no harm, requires healthcare professionals to carefully balance the potential benefits and harms of medical interventions. Invasive procedures and resuscitative measures carry risks and potential complications, especially in the context of a critically ill, elderly patient. The Ethics Team should assess whether the current treatment plan is proportionate to the patient’s prognosis and whether the potential harms outweigh the potential benefits.

4. Family Dynamics:
Family members play an important role in decision-making, particularly when patients are unable to advocate for themselves. However, disagreements between the patient’s family and healthcare team may arise when family members prioritize aggressive treatments despite a poor prognosis. The Ethics Team should engage in open dialogue with the family to understand their concerns, values, and beliefs to facilitate a shared decision-making process that respects the patient’s best interests.

Conclusion:
Managing an elderly patient with end-stage lung cancer presents intricate ethical considerations. Informed by the principles of autonomy, beneficence, non-maleficence, and considering the dynamics of the patient’s family, an Ethics Team consult is essential to navigate the complex decision-making process. Collaboration among healthcare professionals, the patient’s family, and the Ethics Team will facilitate a comprehensive exploration of the patient’s values, goals, and overall best interests.