que--ethics - targt250 - Printable Version +- USMLE Forum - Largest USMLE Community (https://www.usmleforum.com) +-- Forum: USMLE Forum (https://www.usmleforum.com/forumdisplay.php?fid=1) +--- Forum: Step 2 CK (https://www.usmleforum.com/forumdisplay.php?fid=3) +--- Thread: que--ethics - targt250 (/showthread.php?tid=764082) |
que--ethics - targt250 - ArchivalUser - 01-14-2014 A 74-year-old woman with dementia has been in the intensive care unit (ICU) for 14 days following acute respiratory decompensation and renal failure. She is receiving continuous hemodialysis, and her electrolytes have been stable. Her oxygen saturation has been maintained on mandatory mechanical ventilation. She remains in critical condition, but the ICU team believes that she has a reasonable chance of recovering. A living will shows that she has agreed to intubation and resuscitation if necessary. However, her daughter, who is her designated health care proxy and who until now has 0 - ArchivalUser - 01-14-2014 been in contact with the medical team only by phone, arrives stating that she has power of attorney and asking that her mother be taken off the ventilator. Which of the following is the best course of action? (A) Discuss with the daughter her reasons for withdrawing care (B) Maintain current management based on the patient’s prognosis © Obtain a court order mandating continuation of ventilatory support (D) Obtain an ethics consultation (E) Withdraw ventilatory support based on the daughter’s power of attorney 0 - ArchivalUser - 01-14-2014 A???? 0 - ArchivalUser - 01-14-2014 A living will shows that she has agreed to intubation and resuscitation if necessary. B? 0 - ArchivalUser - 01-15-2014 I thought B too...because a living will is superior... I think... 0 - ArchivalUser - 01-15-2014 I think b because living will is there but just talking over the phone cant be trusted although health power of attorney beats all 0 - ArchivalUser - 01-15-2014 I don't think pt prognosis means pt wishes some times may be the prognosis poor but the pt still wish to resuscitate so I think .....a is the answer 0 - ArchivalUser - 01-15-2014 The correct answer is A. Before any decision regarding this patient’s care is undertaken, the daughter’s reasoning must be elucidated. Although she has durable power of attorney, the daughter’s decision clearly disagrees with the patient’s living will. Patients reserve the right to change their decision within a given set of circumstances. However, when a proxy does so, it must be determined whether the patient might have made the same decision. This determination is diffi cult but must be done to rule out any confl ict of interest or ulterior motives by the daughter. Answer B is incorrect. Maintaining current management without fi rst addressing the daughter’s concerns is inappropriate. Answer C is incorrect. If, after questioning, any confl icts of interest are found and the daughter continues to insist on withdrawal ofcare, it may be necessary to obtain a court order to maintain support 0 - ArchivalUser - 01-15-2014 Thank you |