Clinical Ethics: Challenging Cases: Dilemmas for Administrators and Staff Mr. C. is a 41-year-old male, who was admitted to the Medical Center in October of 1995, with a diagnosis of hypoxic encephalopathy. He suffered an acute asthma attack, which resulted in a cardiac arrest and subsequent hypoxia. He was comatose for 2 months, requiring mechanical ventilation for several ... Article
Article  |   October 01, 1997
Clinical Ethics: Challenging Cases: Dilemmas for Administrators and Staff
Author Affiliations & Notes
  • Angela Mandas
    Long Beach Memorial Medical Center, Long Beach, CA
  • Melissa Backstrom
    Loma Linda University Medical Center, Loma Linda, CA
  • Julie Voss
    Loma Linda University Medical Center, Loma Linda, CA
Article Information
Articles
Article   |   October 01, 1997
Clinical Ethics: Challenging Cases: Dilemmas for Administrators and Staff
SIG 11 Perspectives on Administration and Supervision, October 1997, Vol. 7, 11-14. doi:10.1044/aas7.3.11
SIG 11 Perspectives on Administration and Supervision, October 1997, Vol. 7, 11-14. doi:10.1044/aas7.3.11
Mr. C. is a 41-year-old male, who was admitted to the Medical Center in October of 1995, with a diagnosis of hypoxic encephalopathy. He suffered an acute asthma attack, which resulted in a cardiac arrest and subsequent hypoxia. He was comatose for 2 months, requiring mechanical ventilation for several days as well as a tracheostomy tube. He was later decannulated. His past medical history included two previous cardiac arrests, and asthma since childhood. He is married, with two elementary school-aged children, and works for a food manufacturer in the sales department.
When stable, he was transferred to the Rehabilitation Unit, and was seen by Speech Pathology for severe dysphagia, establishing a yes/no communication system, improving his ability to follow one stage commands, improving his attention to task, and providing family education. He remained on the Rehabilitation unit for 2 months, with little improvement. His progress was slow and was hindered by frequent episodes of agitation and resistance to treatment. A behavior management program was established by the team; however, his outbursts and his refusal of treatment continued to be a problem. At the time of discharge, he was unable to take anything by mouth and a gastrostomy tube was placed. He followed one stage commands 20 to 30% of the time, and attended to a task for approximately 30 seconds. Mr. C.’s wife had been given written educational materials on dysphagia and speech and language deficits and was present in many of his therapy sessions. She was aware of his severe dysphagia, and the possible risks associated with oral feeding.
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