Hey everyone! This case was very interesting to me. This case has many perspectives of the same situation to consider.
1) I believe a living will must be very descriptive to be morally decisive. If Esther's will only said "extraordinary means" and nothing further, the doctor was justified in suggesting the surgery. He/she is further justified when Esther consents to the procedure. Her consent may prove that her quality of life, not including the gangrene, is still worth living. There is always a flip side to the situation. If the doctor would have not suggested the procedure to save Esther's life, the family still could have been upset and claim that the procedure was not qualified as extraordinary measures in their opinion.
2) If a grown, stable adult legally consents to a procedure, then whether it coinsides with the physician's wishes or not should be invalid. If the medical staff believed that Esther was too confused to make an informed decision, then a spouse or family member would have been involved. Otherwise, the consent of the patient is all that matters if that is their wish.
3) The family's judgement should not be given weight in this case. Thinking from an unattached POV, all that matters is what Esther wants. The family may think that the procedure falls into the class of "extraordinary means," but Esther may not or may still just want to live. She was given a choice and chose on her own account as an adult.
I look forward to seeing what you guys think, this is a very tricky case based on which POV you take!
This is an interesting case. Here a living will was signed so that no extrodinary means was to be used in prolonging her life. However, the "extrodinary means" that she listed was not surgery to remove and extremity that had been diagnosed with gangrene. I do not fault the doctor for offering the surgery to Esther because I think that one should have the ability to change one's mind in life and death situations. So I think that the living will in this case was specific enough for the situation. If the living will would have included no preventative surgery the hands of the surgeon would have been tied, legally. I think that since Esther appeared "confused" than the family should have been consulted as well, but I think that Esther was somewhat cognitive if she mumbled to the nurse that she was afraid that doctor was would have discharged her from the hospital. If she was fearful that Dr. P would no longer give her medical care couldn't she find a new physician who would care for her needs? In this case I think that consent was only valid legally if Dr. P has knowledge that the only reason she gave consent was fear. Ethically and morally I do not think that any consent given by Esther was valid. If he was going to discharge her from the hospital if no surgery was conducted then, he should have informed her of it. In reguards to the family, I think that they should have been able to discuss the situation with Esther in private. Then with all parties present they should have spoken with the doctor about thier wishes and raised any questions at that time. While I do not feel that Dr. P's actions were justified if he/she knowingly pushed Esther into surgery, but I do believe that there were additional ways of handling it on Esther's part other than simply agreeing to the surgery.
1) I believe that a living will should be pretty specific in order for it to be morally decisive. Family members may interpret something completely differently than what the patient had inteneded. In this case, the family was upset the doctor preformed the surgery even though Esther agreed to it. As previously stated, this type of surgery was not listed as "extradordinary means." A person cannot list every single medical percedure as either acceptable or not acceptable, but the will should be very clean so there is no confusion by the people interpreting it.
2) There isn't any danger of assuming that a consent is valid merely because it coincides with what the physician wishes to do. As long as the patient is able to make a clear decision, there should be no question about their answer. They have the choice of refusing, but they also have the choice of agreeing to the treatment.
3) The family's judgement should be given some weight if you are thinking from a utilitarian point of view. The group should be considered in that case. If you are not taking an ethical perspective into consideration, the family does not have too much weight. Esther made an informed decision and her family should back her up.
This is an interesting case because of the decisiveness of living will.
1. The living will states that the living will is due to the pancreatic cancer not the gangrene. Esther states that that "extraordinary means" is defined as chemotherapy, respirators, or resuscitation efforts. From this definition as her living has nothing to with the surgery as suggested by the doctor.
2. There is danger of assuming the consent is valid due not only to the fact that physician wants it but also due to the fact that the patient is confused and, therefore, can be deemed incompetent. However, the fact that she did give the consent is legally binding without it being specified in extraordinary means.
3. Since it does not state that their is any executor of the will for medical decisions for Esther the family has no say. However, if there was an executor of the living will for when Esther became incompetent the family would have more of a say in in the matter.
1) Based on this case, I think Esther's living will was specific enough to determine the surgery was something she would not want. When filling out a living will it is hard to be so specific that all your wishes are understood, there are so many special situations that wouldn't fall under any part of the will, but based on the person's wishes in other parts of the will, a decision should be able to be made by the family members as to what the loved one would wish to happen. 2) I do believe that consent is often given because the patient or loved one's of the patient believe it is what the physician wants. It would be hard as a physician not to give personal opinion in any case especially if the family is asking for medical advice. I believe the physician should focus more on strictly the positives and negatives of a situation rather than the opinion side and let the family decide from there. 3) Based on this case, because Esther knew she was terminally ill she made a living will so that she can make her own decisions even if she can no longer speak her opinion. I think in the case of Esther's living will she is very clear that she wants all natural causes to run their course with no intervention. When Esther voiced that she wanted to go through with the procedure (something that goes against her will) the family should then have been notified to come in and agree to the decision. The family see's that Esther is to confused to give consent and should reflect back on her will and make the ultimate decision for her.
I agree with Jacob that the surgery to remove the foot was not specified under the "extraordinary means". I believe the living will only intended to not have any aggressive therapies used to prolong Esther's life regarding the pancreatic cancer. I do not think that Dr. P did anything that was unjustified, though. The case states that Esther was only "somewhat confused" and even if she was considered incompetent the living will does not give permission to the family to decide or discuss anything with the doctor legally. Maybe the doctor could have consulted the family first, but what if by then the gangrene spread? Would it be right then if he did not do the surgery? Like Jacob stated she could have changed her mind so if she did not want the surgery she should have asked what her other options were and if that included getting ordered out of the hospital if she didn't do the surgery. Sam is right, all that really matters is what Esther wanted.
This is an interesting case. How can we decide what is meant by "extraordinary means" in any given situation?
1.) It is hard to say how specific a living will needs to be. We cannot provide specification for each potential disease a human will die of. This is impossible. There needs to be three levels of choices on the living will. The first should be absolutely no treatment. This includes all admissions to the hospital, most especially when the patient is not in the correct mental status. This way, all confusion is avoided on if care should be given or not. The second level should include optional care. Optional care is per situation. The patient may decide if desired, but in a situation in which the patient is not mentally stable, the family has the right to decide for the patient. The patient should include in the living will a spokesperson for the family who will decide if her life should be prolonged or ended. The final decision should be care in every situation no matter the harm or chance for survival. This will avoid all confusion, especially in a case of unstable mental status. I believe these three levels will help to clarify some of the confusion between situations in which the living will should be used.
2.) I do believe there is a danger in assuming. As they say... assuming makes "something" out of you and me! It is not in the decision of the physician to decide based on what he thinks is right for the patient. He needs to think of the patient's wants before he thinks of a patient's needs. Though the decision to remove the foot is in the patient's best health interests, it may not be her want or consistent with the living will in her name. Futhermore, the nurse needs to note on her chart that the patient was afraid if she refuse that the doctor would no longer care for her and tell the doctor the information before the operation is proceeded. The doctor then needs to discuss the situation with the patient and reexplain the benefits and disadvantages of the surgery.
3.) I believe this should be a 50/50 decision. Since the patient is not completely in a correct mental status, the family's thoughts should be considered. However, the patient may still be conscious and making decisions for herself. Combining the two opinions will help to decide the next step. If the two are conflicting, I believe there should be a conference with the doctor and nurses working on the patient's case and the family and patient. There, a consensus may be met.
In this case the patient specified what extraordinary means meant to her, which included resuscitation efforts & chemotherapy. I do not believe the patient would have wanted her foot removed if she was in a competent state at the time of surgery.
A living will should act as a guide for the family & doctor when a patient is unable to make rational decisions, or is unable to make any decisions at all. Obviously, her doctor should know if she is in a "confused state", as the article indicated she was. Therefore, he should have made his decision based on her living will & family's wishes.
This article is a good illustration as to how specific people should be when writing a living will to avoid such doctor/family conflicts. These types of documents are not only written to carry out a patient's will when they are unable to speak, but also to relieve their loved ones from having to make heart breaking decisions on their behalf.
1) I think it is not plausible to list out every possible scenario of "extraordinary means." Therefore, it is impossible to say how specific a living will must be to be morally decisive. However, the more specific the living will is written, the less chance a gray area like this case will arise. Esther said she did not want extraordinary means to sustain her life due to the pancreatic cancer. Her issue was gangrene on her foot. Now I don't know if there is any correlation between gangrene and pancreatic cancer (nursing majors feel free to clarify) therefore I don't feel like the living will has weight here. Although she is dying, I do not believe she would want her time to be painful and be even shorter than it already is expected to be. 2) I think the Doctor had every right to suggest the surgery. It would improve the quality of her life she has left, but not sustain it. In this case the cause of her dying is not the gangrene (once again nurses correct me if otherswise), therefore by doing the surgery it is not violating the living will. I do not think the doctor forced her to consent, just provided her with all the options. 3) I believe the family should have input. They may be able to articulate to the patient what the surgery means in a calming and more concise manner than a possibly stern business-like authoritative figure like a doctor. Then, the patient could make a decision with more conviction.
I also think that it is important for a person to specify in a living will what exactly they want to have done if the time ever came necessary to make a decision. I think that if the patient has a specific section for example I do not want any surgery that will prolong my life then the doctor would have to honor this request. I think that it is important for a person to have a living will, but I think that talking with each other in a family is important because if the patient talks with the family then that family won't have such a hard time deciding what their mother, sister etc. wants. If the family has to decide what the patient wants it can be hard for them because they don't want to accept that their family member is ill.
As far as question 2 is concerned I think it is necessary for the patient to sit with his/her family and decide what they want before even talking with the doctor so that there is not a danger of the doctors opinion influencing the decision. As for question number 3 the family judgment is important because the whole family needs to decide together what they want to do if there is an emergency. I think that the patient should have the ultimate decision, but allowing the family to talk it out helps the situation.
This is a difficult case because the Living Will did not specify if any surgeries could be conducted. Esther did make it clear that she did not want any "extraordinary means" taken. In this case she should have told Dr. P, and her family what her definition of "Extraordinary means" was. For this reason, living wills need to be not only made, but also discussed. If Esther felt intimidated or afraid of Dr. P she should have told her family. Likewise, I think the nurse should have told Dr. P that she was a bit scared that Dr. P would stop treating her. In doing so Dr. P could have talked with Esther, and told her how he feels or just what actions would come from not taking extraordinary means. I do feel the family has some reason to be upset. Ultimately, since there is a living will the family does not have a say in this, but if Esther mentioned to the nurse that she was afraid then she would have had to mention it to the family, which they could have brought to Dr. P. Since the concern was not brought to Dr. P then he should take the consent of Esther. I would assume if Dr. P had any concern that Esther was not in the right state of mind to make the decsion then he would have asked the family what their thoughts were.
1. In my opinion a living will needs to be very specific in order for it to be morally decisive. If you are not specific in your living will then it leaves alot up for interpretation and if you are in a state, like Esther K where you are not able to make a competent decision, then your family members may make a decision that is not exactly what you would have necessarily wanted.
2. There is always a danger in assuming anything. A patinet that is in a confused state should never be asked to give consent because she is not seen as competent and therefore the consent that the doctor obtained would not be valid. In this case the living will should be followed because the patient is not competent. If the surgeon were to do the surgery and something went wrong and/ or the patinet's condition improves and becomes competent and is upset that the surgery was performed, the surgeon is in danger of being sued because informed consent was not actually received because the patient was not competent at the time the surgeon received the consent.
3. The family's judgement should always be considered. If the famiy members are not comfortable with what is being done then the healthcare workers need to listen to them especially if they are trying to uphold a living will. In this case the family is trying to abide by the patient's wishes and uphold her living will. What the surgeon should do is to do nothing because one he does not have a valid informed consent and two the living will states that the patient does not want to have any extraordinary measures. Now in this case the patient's definition of extratrodinary means does not specifically include surgery as an extraordinary mean, but because the family is not agreeing to the surgery the surgeon should speak to the POA, the next of kin, or wait until the patient is in a more competent state.
1. I think that you need to be very specific in a living will to avoid situations like Esther K. However, i do realize that it is not plausible to list every medical procedure you wish to have or not have. 2. Yes, I believe it is dangerous to assume a consent is valid just becuase its in line with what the physician wishes to do. I think that the Dr. was in the wrong to ask Ether K. in the first place, knowing that she is in a confused state. 3. I think that in this case especially the families judgment should be given alot of weight. First off, they are trying to go by the pt. living will as best as possible and secondly they are family so they are going to know what is best or in the best regards for Esther.
Hey everyone! This case was very interesting to me. This case has many perspectives of the same situation to consider.
ReplyDelete1) I believe a living will must be very descriptive to be morally decisive. If Esther's will only said "extraordinary means" and nothing further, the doctor was justified in suggesting the surgery. He/she is further justified when Esther consents to the procedure. Her consent may prove that her quality of life, not including the gangrene, is still worth living. There is always a flip side to the situation. If the doctor would have not suggested the procedure to save Esther's life, the family still could have been upset and claim that the procedure was not qualified as extraordinary measures in their opinion.
2) If a grown, stable adult legally consents to a procedure, then whether it coinsides with the physician's wishes or not should be invalid. If the medical staff believed that Esther was too confused to make an informed decision, then a spouse or family member would have been involved. Otherwise, the consent of the patient is all that matters if that is their wish.
3) The family's judgement should not be given weight in this case. Thinking from an unattached POV, all that matters is what Esther wants. The family may think that the procedure falls into the class of "extraordinary means," but Esther may not or may still just want to live. She was given a choice and chose on her own account as an adult.
I look forward to seeing what you guys think, this is a very tricky case based on which POV you take!
This is an interesting case. Here a living will was signed so that no extrodinary means was to be used in prolonging her life. However, the "extrodinary means" that she listed was not surgery to remove and extremity that had been diagnosed with gangrene. I do not fault the doctor for offering the surgery to Esther because I think that one should have the ability to change one's mind in life and death situations. So I think that the living will in this case was specific enough for the situation. If the living will would have included no preventative surgery the hands of the surgeon would have been tied, legally. I think that since Esther appeared "confused" than the family should have been consulted as well, but I think that Esther was somewhat cognitive if she mumbled to the nurse that she was afraid that doctor was would have discharged her from the hospital. If she was fearful that Dr. P would no longer give her medical care couldn't she find a new physician who would care for her needs?
ReplyDeleteIn this case I think that consent was only valid legally if Dr. P has knowledge that the only reason she gave consent was fear. Ethically and morally I do not think that any consent given by Esther was valid. If he was going to discharge her from the hospital if no surgery was conducted then, he should have informed her of it.
In reguards to the family, I think that they should have been able to discuss the situation with Esther in private. Then with all parties present they should have spoken with the doctor about thier wishes and raised any questions at that time.
While I do not feel that Dr. P's actions were justified if he/she knowingly pushed Esther into surgery, but I do believe that there were additional ways of handling it on Esther's part other than simply agreeing to the surgery.
1) I believe that a living will should be pretty specific in order for it to be morally decisive. Family members may interpret something completely differently than what the patient had inteneded. In this case, the family was upset the doctor preformed the surgery even though Esther agreed to it. As previously stated, this type of surgery was not listed as "extradordinary means." A person cannot list every single medical percedure as either acceptable or not acceptable, but the will should be very clean so there is no confusion by the people interpreting it.
ReplyDelete2) There isn't any danger of assuming that a consent is valid merely because it coincides with what the physician wishes to do. As long as the patient is able to make a clear decision, there should be no question about their answer. They have the choice of refusing, but they also have the choice of agreeing to the treatment.
3) The family's judgement should be given some weight if you are thinking from a utilitarian point of view. The group should be considered in that case. If you are not taking an ethical perspective into consideration, the family does not have too much weight. Esther made an informed decision and her family should back her up.
This is an interesting case because of the decisiveness of living will.
ReplyDelete1. The living will states that the living will is due to the pancreatic cancer not the gangrene. Esther states that that "extraordinary means" is defined as chemotherapy, respirators, or resuscitation efforts. From this definition as her living has nothing to with the surgery as suggested by the doctor.
2. There is danger of assuming the consent is valid due not only to the fact that physician wants it but also due to the fact that the patient is confused and, therefore, can be deemed incompetent. However, the fact that she did give the consent is legally binding without it being specified in extraordinary means.
3. Since it does not state that their is any executor of the will for medical decisions for Esther the family has no say. However, if there was an executor of the living will for when Esther became incompetent the family would have more of a say in in the matter.
1) Based on this case, I think Esther's living will was specific enough to determine the surgery was something she would not want. When filling out a living will it is hard to be so specific that all your wishes are understood, there are so many special situations that wouldn't fall under any part of the will, but based on the person's wishes in other parts of the will, a decision should be able to be made by the family members as to what the loved one would wish to happen.
ReplyDelete2) I do believe that consent is often given because the patient or loved one's of the patient believe it is what the physician wants. It would be hard as a physician not to give personal opinion in any case especially if the family is asking for medical advice. I believe the physician should focus more on strictly the positives and negatives of a situation rather than the opinion side and let the family decide from there.
3) Based on this case, because Esther knew she was terminally ill she made a living will so that she can make her own decisions even if she can no longer speak her opinion. I think in the case of Esther's living will she is very clear that she wants all natural causes to run their course with no intervention. When Esther voiced that she wanted to go through with the procedure (something that goes against her will) the family should then have been notified to come in and agree to the decision. The family see's that Esther is to confused to give consent and should reflect back on her will and make the ultimate decision for her.
I agree with Jacob that the surgery to remove the foot was not specified under the "extraordinary means". I believe the living will only intended to not have any aggressive therapies used to prolong Esther's life regarding the pancreatic cancer. I do not think that Dr. P did anything that was unjustified, though. The case states that Esther was only "somewhat confused" and even if she was considered incompetent the living will does not give permission to the family to decide or discuss anything with the doctor legally. Maybe the doctor could have consulted the family first, but what if by then the gangrene spread? Would it be right then if he did not do the surgery? Like Jacob stated she could have changed her mind so if she did not want the surgery she should have asked what her other options were and if that included getting ordered out of the hospital if she didn't do the surgery. Sam is right, all that really matters is what Esther wanted.
ReplyDeleteThis is an interesting case. How can we decide what is meant by "extraordinary means" in any given situation?
ReplyDelete1.) It is hard to say how specific a living will needs to be. We cannot provide specification for each potential disease a human will die of. This is impossible. There needs to be three levels of choices on the living will. The first should be absolutely no treatment. This includes all admissions to the hospital, most especially when the patient is not in the correct mental status. This way, all confusion is avoided on if care should be given or not. The second level should include optional care. Optional care is per situation. The patient may decide if desired, but in a situation in which the patient is not mentally stable, the family has the right to decide for the patient. The patient should include in the living will a spokesperson for the family who will decide if her life should be prolonged or ended. The final decision should be care in every situation no matter the harm or chance for survival. This will avoid all confusion, especially in a case of unstable mental status. I believe these three levels will help to clarify some of the confusion between situations in which the living will should be used.
2.) I do believe there is a danger in assuming. As they say... assuming makes "something" out of you and me! It is not in the decision of the physician to decide based on what he thinks is right for the patient. He needs to think of the patient's wants before he thinks of a patient's needs. Though the decision to remove the foot is in the patient's best health interests, it may not be her want or consistent with the living will in her name. Futhermore, the nurse needs to note on her chart that the patient was afraid if she refuse that the doctor would no longer care for her and tell the doctor the information before the operation is proceeded. The doctor then needs to discuss the situation with the patient and reexplain the benefits and disadvantages of the surgery.
3.) I believe this should be a 50/50 decision. Since the patient is not completely in a correct mental status, the family's thoughts should be considered. However, the patient may still be conscious and making decisions for herself. Combining the two opinions will help to decide the next step. If the two are conflicting, I believe there should be a conference with the doctor and nurses working on the patient's case and the family and patient. There, a consensus may be met.
In this case the patient specified what extraordinary means meant to her, which included resuscitation efforts & chemotherapy. I do not believe the patient would have wanted her foot removed if she was in a competent state at the time of surgery.
ReplyDeleteA living will should act as a guide for the family & doctor when a patient is unable to make rational decisions, or is unable to make any decisions at all. Obviously, her doctor should know if she is in a "confused state", as the article indicated she was. Therefore, he should have made his decision based on her living will & family's wishes.
This article is a good illustration as to how specific people should be when writing a living will to avoid such doctor/family conflicts. These types of documents are not only written to carry out a patient's will when they are unable to speak, but also to relieve their loved ones from having to make heart breaking decisions on their behalf.
1) I think it is not plausible to list out every possible scenario of "extraordinary means." Therefore, it is impossible to say how specific a living will must be to be morally decisive. However, the more specific the living will is written, the less chance a gray area like this case will arise. Esther said she did not want extraordinary means to sustain her life due to the pancreatic cancer. Her issue was gangrene on her foot. Now I don't know if there is any correlation between gangrene and pancreatic cancer (nursing majors feel free to clarify) therefore I don't feel like the living will has weight here. Although she is dying, I do not believe she would want her time to be painful and be even shorter than it already is expected to be.
ReplyDelete2) I think the Doctor had every right to suggest the surgery. It would improve the quality of her life she has left, but not sustain it. In this case the cause of her dying is not the gangrene (once again nurses correct me if otherswise), therefore by doing the surgery it is not violating the living will. I do not think the doctor forced her to consent, just provided her with all the options.
3) I believe the family should have input. They may be able to articulate to the patient what the surgery means in a calming and more concise manner than a possibly stern business-like authoritative figure like a doctor. Then, the patient could make a decision with more conviction.
I also think that it is important for a person to specify in a living will what exactly they want to have done if the time ever came necessary to make a decision. I think that if the patient has a specific section for example I do not want any surgery that will prolong my life then the doctor would have to honor this request. I think that it is important for a person to have a living will, but I think that talking with each other in a family is important because if the patient talks with the family then that family won't have such a hard time deciding what their mother, sister etc. wants. If the family has to decide what the patient wants it can be hard for them because they don't want to accept that their family member is ill.
ReplyDeleteAs far as question 2 is concerned I think it is necessary for the patient to sit with his/her family and decide what they want before even talking with the doctor so that there is not a danger of the doctors opinion influencing the decision. As for question number 3 the family judgment is important because the whole family needs to decide together what they want to do if there is an emergency. I think that the patient should have the ultimate decision, but allowing the family to talk it out helps the situation.
ReplyDeleteThis is a difficult case because the Living Will did not specify if any surgeries could be conducted. Esther did make it clear that she did not want any "extraordinary means" taken. In this case she should have told Dr. P, and her family what her definition of "Extraordinary means" was. For this reason, living wills need to be not only made, but also discussed.
ReplyDeleteIf Esther felt intimidated or afraid of Dr. P she should have told her family. Likewise, I think the nurse should have told Dr. P that she was a bit scared that Dr. P would stop treating her. In doing so Dr. P could have talked with Esther, and told her how he feels or just what actions would come from not taking extraordinary means. I do feel the family has some reason to be upset. Ultimately, since there is a living will the family does not have a say in this, but if Esther mentioned to the nurse that she was afraid then she would have had to mention it to the family, which they could have brought to Dr. P. Since the concern was not brought to Dr. P then he should take the consent of Esther. I would assume if Dr. P had any concern that Esther was not in the right state of mind to make the decsion then he would have asked the family what their thoughts were.
1. In my opinion a living will needs to be very specific in order for it to be morally decisive. If you are not specific in your living will then it leaves alot up for interpretation and if you are in a state, like Esther K where you are not able to make a competent decision, then your family members may make a decision that is not exactly what you would have necessarily wanted.
ReplyDelete2. There is always a danger in assuming anything. A patinet that is in a confused state should never be asked to give consent because she is not seen as competent and therefore the consent that the doctor obtained would not be valid. In this case the living will should be followed because the patient is not competent. If the surgeon were to do the surgery and something went wrong and/ or the patinet's condition improves and becomes competent and is upset that the surgery was performed, the surgeon is in danger of being sued because informed consent was not actually received because the patient was not competent at the time the surgeon received the consent.
3. The family's judgement should always be considered. If the famiy members are not comfortable with what is being done then the healthcare workers need to listen to them especially if they are trying to uphold a living will. In this case the family is trying to abide by the patient's wishes and uphold her living will. What the surgeon should do is to do nothing because one he does not have a valid informed consent and two the living will states that the patient does not want to have any extraordinary measures. Now in this case the patient's definition of extratrodinary means does not specifically include surgery as an extraordinary mean, but because the family is not agreeing to the surgery the surgeon should speak to the POA, the next of kin, or wait until the patient is in a more competent state.
1. I think that you need to be very specific in a living will to avoid situations like Esther K. However, i do realize that it is not plausible to list every medical procedure you wish to have or not have.
ReplyDelete2. Yes, I believe it is dangerous to assume a consent is valid just becuase its in line with what the physician wishes to do. I think that the Dr. was in the wrong to ask Ether K. in the first place, knowing that she is in a confused state.
3. I think that in this case especially the families judgment should be given alot of weight. First off, they are trying to go by the pt. living will as best as possible and secondly they are family so they are going to know what is best or in the best regards for Esther.