ethics - elbamaritza

[ArchivalUser]

An elderly female who has been your patient for several years is discovered lying on the floor
of her kitchen by a Meals-on-Wheels volunteer. She is transported to the hospital in an
unresponsive state. After a thorough evaluation, you diagnose a massive cerebral infarct. On
several previous occasions the patient verbalized to you her desire to not be subjected to
life-prolonging treatments should she ever be rendered incapacitated; however, she declined
your suggestion that she confirm this in writing. The patient is admitted to the hospital with œdo
not resuscitate (DNR) orders and supportive measures are instituted. A neurology consultant
evaluates her and agrees that her condition is terminal and irreversible. The patient™s nephew
is angered by the DNR status and, noting that she has Medicare coverage, demands every
medical treatment that might prolong his aunt™s life, including resuscitation.
Which one of the following would be the best course of action in terms of legality and ethics?
A) Institution of aggressive medical therapies, including full resuscitation in the event of
cardiac arrest and ventilator support in the event of respiratory arrest
B) Continuation of a supportive treatment plan, provided full resuscitation is initiated in
the event of cardiac arrest and ventilator support is provided in the event of respiratory
arrest
C) Performance of full CPR for cardiopulmonary arrest, but no ventilator support for
respiratory failure
D) Continuation of the current treatment plan

[ArchivalUser]

D continuation of the current treatment plan

[ArchivalUser]

C.

[ArchivalUser]

ANSWER: D
An adult patient or their legally authorized representative has the right to refuse any medical treatment,
regardless of its likelihood of success; however, there is no legal right to receive any and all treatment
demanded. When patients have explicit advance directives in writing, their wishes are clear. When no
written document exists, but the patient™s desire is well known to his or her physician, the physician is
ethically bound to honor these wishes. This responsibility must be balanced against the physician™s ethical
obligation not to perform futile treatments of no benefit to the patient. A family member acting as a
medical decision-making proxy is obligated to represent what they believe to be the patient™s wishes, even
in the face of conflict with their personal beliefs.
This case highlights two commonly encountered issues: honoring the patient™s wishes when there is
conflicting evidence of what their wishes may be, and withholding medically futile treatment. In this case,
the futility of the patient™s condition overrides any confusion as to her wishes, and the admission treatment
plan is the most appropriate. Naturally, it would be best to discuss this with the nephew and attempt to
arrive at a consensus, with the patient™s best interest being the primary concern.
Ref: Putnam A: Do I have to resuscitate this patient against her wishes? Am Fam Physician 2003;67(9):2025-2026.

[ArchivalUser]

thks elbamaritza
u correct my doubts with this q, i read in somewhere that DNR doesn't mean CPR, so i took choose C, now i clear my doubt, thanks

[ArchivalUser]

Thank u so much for ur Q & explanations..

[ArchivalUser]

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[ArchivalUser]

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