Dr. Johnstone didn’t like what he saw.  The x-rays of Gladys Gwynn’s hip showed a fracture of the femoral neck and severe osteoporosis of the hip.  Mrs. Gwynn had been admitted to the orthopedic ward of Hamilton Hospital after a fall that morning at Sunny Meadows, an assisted-living facility.  The accident had occurred when Sheri Smith, a new aide, lost her grip while helping Mrs. Gwynn in the shower.

A frail but alert and cheerful woman of 85, Mrs. Gwynn has osteoarthritis and osteoporosis that have forced her to rely on a walker.  Although her finances were limited, she has been living at Sunny Meadows since her husband’s death four years ago.  Dr. Johnstone knew that she didn’t have any close relatives, and he did not think that she had signed a Health Care Power of Attorney designating someone to help with medical decisions like this.

A total hip replacement would be the logical treatment for a younger patient because it could restore some of her lost mobility.  However, for a frail patient like Mrs. Gwynn, internal fixation of the fracture might be the treatment of choice.  This would repair the break but not improve her mobility.

Dr. Johnstone needs to make a decision soon, but he knows that Mrs. Gwynn is groggy from pain medication.  With one more look at the x-ray, Dr. Johnstone sighs and walks toward Mrs. Gwynn’s room.

Because of the pain medication, Gladys Gwynn may not be able to speak for herself.  Since she has no relatives to help, is it appropriate for Dr. Johnstone to make the decision about surgery for her?  Given these circumstances, is it possible that when Gladys moved into Sunny Meadows they had her sign a Health Care Power of Attorney to someone in the facility?

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