07-16-2012, 11:49 PM
A 67-year-old woman has suffered a massive subarachnoid hemorrhage. The patient was well until three days prior when she had a sudden loss of consciousness. After emergent transport to the local hospital where her trachea was intubated and a CT scan disclosed a large grade 4 subarachnoid bleed, she was transferred to the intensive care unit. Over the past 72 hours her condition is unchanged. She is nonresponsive to deep painful stimulus, there is no dolls' eye or gag reflex, and corneal blink reflex is absent. She has had no narcotics, analgesics, or paralytics. There is discord present within the family about whether to withdraw care. The husband desires care to be withdrawn whereas the children want to continue maximal supportive care.
You explain that the most important determining factor in helping to direct future care is
A. the decision of a court-appointed legal guardian
B. the decision of the medical and nursing team taking care of the patient
C. the husband's wishes, given that he is the healthcare proxy
D. the opinion of the hospital ethics committee
E. the patient's previously expressed wishes regarding life support if known
You explain that the most important determining factor in helping to direct future care is
A. the decision of a court-appointed legal guardian
B. the decision of the medical and nursing team taking care of the patient
C. the husband's wishes, given that he is the healthcare proxy
D. the opinion of the hospital ethics committee
E. the patient's previously expressed wishes regarding life support if known
