Below is a complete IHP 420 Module 6 paper on an end-of-life surrogate dispute over tube feeding, covering advance directive law, surrogate hierarchy, the Cruzan evidence standard, substituted judgment and best interests, the burden on surrogates and a recommended process. Searches like "ihp 420 module 6 assignment", "ihp420 module 6 end-of-life decision assignment" and "ihp 420 module 6 example" land here.
The IHP 420 Module 6 example, in full
Her Husband, Her Sister and a Feeding Tube: Surrogate Authority Without an Advance Directive
[Student Name]
Southern New Hampshire University
IHP 420: Ethical and Legal Considerations of Healthcare
Module Six Assignment
[Instructor Name]
[Date]
The organization, setting and figures below are a composite written as a model document. No real employer, client, colleague or patient is described.
Her Husband, Her Sister and a Feeding Tube: Surrogate Authority Without an Advance Directive
The Case
Mrs. Lindahl is a composite 58-year-old office manager who had a cardiac arrest at home. She was resuscitated after about 20 minutes but suffered severe anoxic brain injury. Three months later, neurologists have diagnosed a persistent vegetative state with very little chance of meaningful recovery. She breathes on her own and receives nutrition through a gastrostomy tube in a long-term care unit. She never completed an advance directive or named a health care agent. Her husband of 30 years says she told him more than once, after caring for her own father, that she would never want to be kept alive by machines if she could not know her family. Her sister, who is close to her, says Mrs. Lindahl was devoutly religious and would want every chance at life. They ask the team to decide.
The Legal Framework
Competent adults have a right to refuse medical treatment, including artificial nutrition and hydration. Deciding the case of a young Missouri woman left permanently unconscious after a car crash, the U.S. Supreme Court recognized a constitutionally protected liberty interest in refusing unwanted treatment and held that a state may require clear and convincing evidence of an incapacitated patient's wishes before life-sustaining treatment is withdrawn (Cruzan v. Director, Missouri Department of Health, 1990). States differ in the evidence they require. Federal law also requires hospitals and nursing facilities that participate in Medicare and Medicaid to inform adult patients of their rights to make advance directives (Patient Self-Determination Act, 1990). Mrs. Lindahl's case shows what happens when that information never becomes a written document: the decision falls to people who remember her differently.
Who Holds Surrogate Authority
Without an advance directive or a court-appointed guardian, most states rely on a surrogate consent statute that lists family members in order of priority, and nearly all place a spouse first, followed by adult children, parents and siblings. Under such a statute, Mr. Lindahl is the legal surrogate. His sister-in-law's views should be heard, and they may help the team understand the patient, but they do not carry equal legal authority. If the state requires clear and convincing evidence to withdraw nutrition, the husband's account of repeated, specific statements will be important, and the hospital's lawyer should confirm the applicable standard before any action is taken.
The Ethical Standards a Surrogate Must Apply
The surrogate's task is not to choose what he wants but to represent the patient. The preferred standard is substituted judgment: deciding as the patient would have decided, based on her values and statements (Beauchamp & Childress, 2019). Here, the husband reports specific statements tied to a concrete experience, caring for her father, which is strong evidence of her wishes. The sister points to religious faith, which matters but does not by itself show what Mrs. Lindahl wanted about this treatment; many people of deep faith accept withdrawal of treatment that only prolongs a permanent unconscious state. The team should ask the sister whether Mrs. Lindahl ever spoke about such situations, and whether her faith community has teachings she accepted about them. If her wishes could not be known, the best interests standard would apply, weighing the burdens and benefits of continued treatment for a patient with no awareness.
The Burden on Surrogates and Family
Surrogate decisions are heavy. A systematic review of 40 studies found that at least a third of surrogates experienced a negative emotional burden, including stress, guilt and doubt, often lasting months or years, and that knowing which treatment was consistent with the patient's wishes helped reduce it (Wendler & Rid, 2011). This evidence supports two practices: helping the surrogate focus on what the patient would want rather than on what he wants, and supporting the family through the process rather than leaving them to fight it out.
Recommended Process
The facility should follow a structured process. First, hold a family meeting led by the attending physician with a palliative care clinician and a chaplain, to review the prognosis, share each person's understanding of Mrs. Lindahl's values and document her statements carefully. Second, request an ethics consultation to confirm that the husband is applying substituted judgment and that the evidence meets the state's standard. Third, offer time; there is no medical emergency, and a short period can allow the sister to be heard and perhaps to accept the decision. Fourth, if agreement cannot be reached and the evidence is disputed, the facility should seek legal advice about whether court review is needed, rather than acting unilaterally. If the decision is made to withdraw tube feeding, palliative care should ensure comfort and support the family throughout.
Documenting the Decision
Whatever the outcome, the record must show how it was reached. The chart should include the neurologists' prognosis and its basis, the names of those present at each family meeting, the specific statements the husband attributes to Mrs. Lindahl and when she made them, the sister's account and any evidence she offers, the ethics consultant's analysis, and the legal standard the facility applied. If tube feeding is withdrawn, the order should be written by the attending physician with a palliative care plan attached. Careful documentation protects the patient's wishes, supports the family if the decision is questioned later, and allows the facility to show that it followed its policy and the law rather than simply siding with one relative.
Preventing the Next Dispute
The case began with a missing document. The facility can reduce future conflicts by building advance care planning into routine care: asking every adult on admission whether they have a directive and a named agent, offering help to complete one, and storing it where every clinician can find it. The Patient Self-Determination Act requires hospitals to inform patients of their rights; an ethical organization goes further and helps patients act on them.
Conclusion
Without an advance directive, the decision about Mrs. Lindahl's feeding tube falls to her husband under typical state surrogate law, subject to the state's evidentiary standard as permitted by the Cruzan decision. Ethically, he must use substituted judgment, and his account of her specific statements is strong evidence of her wishes. A structured process with family meetings, ethics consultation, time and legal review when needed respects both the patient and a grieving family.
References
Beauchamp, T. L., & Childress, J. F. (2019). Principles of biomedical ethics (8th ed.). Oxford University Press.
Cruzan v. Director, Missouri Department of Health, 497 U.S. 261 (1990).
Patient Self-Determination Act, Pub. L. No. 101-508, 104 Stat. 1388 (1990).
Wendler, D., & Rid, A. (2011). Systematic review: The effect on surrogates of making treatment decisions for others. Annals of Internal Medicine, 154(5), 336-346. https://doi.org/10.7326/0003-4819-154-5-201103010-00008
How this IHP 420 Module 6 example is structured
Its sections take the hospital's questions in the sequence it has to settle them. It opens with the case and the absence of a directive. It then establishes the legal framework: the right to refuse treatment, the role of advance directives, and the Supreme Court's ruling on evidence of an incapacitated patient's wishes. A section identifies who holds surrogate authority, followed by the ethical standards a surrogate must apply. The paper closes with a recommended process for resolving the dispute and a note on preventing similar conflicts.
Get IHP 420 Module 6 written to your instructions
Send your IHP 420 Module 6 assignment, the rubric and the end-of-life scenario you were given. A paper arguing directives and surrogate authority together comes back within 24 to 48 hours; the first is free. The paper above is an original model document written by our desk, not a submitted student paper and not an official Southern New Hampshire University document.
IHP 420 Module 6 questions, answered
What does IHP 420 Module 6 usually cover?
Around this module, health care law and ethics courses commonly address end-of-life decisions: advance directives, health care powers of attorney, surrogate decision-makers, withholding and withdrawing treatment, and the legal and ethical standards that guide decisions for patients who cannot speak for themselves.
What is the difference between substituted judgment and best interests?
Substituted judgment asks the surrogate to decide as the patient would have decided, based on the patient's known values and statements. The best interests standard applies when the patient's wishes cannot be known, and asks what would most benefit the patient, weighing burdens and benefits.
What did the Cruzan decision decide?
In its 1990 Cruzan ruling, the U.S. Supreme Court recognized that a competent person has a constitutionally protected interest in refusing unwanted treatment, nutrition and hydration included, and allowed states to demand clear and convincing evidence of an incapacitated patient's wishes before such treatment is withdrawn.