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* treat or not treat?
  alan - 10/28/06 23:45
  John, recent Dx Huntington's disease, it leaves him 10 years to live. he refuses all Tx as he saw how his mom suffered and died from this illness. He was depressed, he went to see psy and asked for help to end of his life, sure he was day His wife found him passed out in the bathroom with an empty TCA bottle, there was a note he attached to his cloth to indicate he wanted to end his life as he got this disease. Wife rashed him to ED. Wife requested to save his life. Drug OD is treatable and Huntington's is incurable and pt wanted to die becasue of his huntington's. What do you suggest EdD team do now?  
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* Re:treat or not treat?
  logic - 10/28/06 23:50
  I think save his life, he has 10 years to live , it is not few months. On ethical ground also we shud save him.  
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* Re:treat or not treat?
  humerus - 10/28/06 23:50
  save him. suicide isnt permissible, no matter how bad his medical condition.  
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* Re:treat or not treat?
  dia - 10/28/06 23:53
  I don't know the answer, but I know that any depression pt. is treated - the patient cannot make a decision while in depression.
I think he gets treatment for depression.
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* Re:treat or not treat?
  alan - 10/29/06 00:00
Several factors in the context of this case are significant. While the patient has a legal right to refuse treatment, he is currently unconscious and his surrogate (his wife) is requesting treatment. There are also certain emergency room obligations to treat emergent conditions. How should the emergency staff weigh the various competing legal and regulatory duties
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* Re:treat or not treat?
  humerus - 10/29/06 00:08
  treat like any other suicide case... save first, ask questions later.

like dia said, later his depression can be tackled more efficiently to make sure he doesnt lapse into a suicidal state.. though its v common with huntingtons.

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* Re:treat or not treat?
  3stepstomle - 10/29/06 00:11
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* Re:treat or not treat?
  alan - 10/29/06 00:12
  you got it.

The precedent for cases such as this one is fairly clear. When the patient's preferences are unclear, and the acute condition is easily treatable, and the harm of not treating is very great, medical teams can feel comfortable about providing the treatment for the immediate life-threatening condition, creating an opportunity to talk with the patient about his preferences regarding his chronic condition at a later time.

Notice that the facts of this particular case determine if the precedent case is applicable. If the medical team was very familiar with this patient's expressed preference to refuse any medical treatment or if the available treatment for the acute condition was considerably less certain to be effective, the case could be decided differently. The clinicians would look for a different precedent or consider whether it made a significant difference to be very clear about the patient's beliefs and certain about his competency to decide to refuse.
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* Re:treat or not treat?
  alan - 10/29/06 00:14
We know from the patient's suicide note that he is refusing all medical treatment. However, what do we know about these statements of preference? Were they informed? Was the patient competent to make that decision? The answers to these questions remain unclear, but we do know that the patient does not have decision making capacity for the present decision of whether to proceed with the gastric emptying. Is there a surrogate decisionmaker available?
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