The Patient's Wishes An 86-ycar-old widower resides in an assisted living facility. He has one adult daughter who lives out of town and regularly visits him twice a month. One morning, the care...

The Patient's Wishes

An 86-ycar-old widower resides in an assisted living facility. He has one adult daughter who lives out of town and regularly visits him twice a month. One morning, the care providers at the facility find him unresponsive with shallow respirations and a bradycardic pulse. A note, written by Mr.Johnson, states that he intentionally took a lethal overdose and that he does not wish to be resuscitated. Empty bottles oflevodopa and amitriptyline are found in his room next to a glass partially filled with alcohol. Residents of the facility said that Mr. Johnson had continued to express sadness over the loss of his wife 2 years ago and that progression of his Parkinson disease also was troubling to him. The providers at the facility call the rescue squad, and he is rapidly transported to the hospital.

The patient is hypotensive and unresponsive on admission to the medical ICU. Laboratory tests reflecting his renal and hepatic function are grossly abnormal. Gastric lavage and activated charcoal are initiated to address the overdose.

The patient's daughter requests that everything be done to save her father. The healthcare team respects the daughter's wishes as surrogate but is concerned that this is not what the patient wanted. They believe that the likelihood of a full recovery is remote, and that he should be allowed a peaceful death.

: What factors need to be considered to evaluate Mr. J ohn1on's capacity when he wrote the statement indicating he did not desire resuscitation?

What guidance can Mr.John1on'1 nurse offer to his daughter to help her in her role as surrogate decision maker?