07-01-2008, 10:21 AM
A 26-year-woman who experienced severe brain injury as a result of a motor vehicle accident several weeks ago undergoes neurologic examination. Since the accident, she has remained in a deep coma, with no evidence of consciousness or any purposeful movement. She is receiving nutrition, hydration, and medications through a nasogastric tube.
After her neurologic examination, the patient's family is told that her clinical signs and symptoms are likely indicative of an impending persistent vegetative state. Her entire family, including her husband who is her formally designated health care proxy, recall numerous conversations with the patient in which she expressed the desire for life-prolonging efforts, assuming there were a reasonable possibility of recovery allowing her to interact with her family; however, she rejected the prospect of life-sustaining measures if it were determined with reasonable medical certainty that she was going to be in a permanently unconscious state. Family members resist placement of a gastrostomy tube because they worry that once this type of support is initiated, it cannot legally be discontinued; however, they understand that it would provide optimal access for medications, nutrition, and fluids.
Which of the following is the most appropriate recommendation for this patient's family?
A Continue nasogastric tube feedings
B Initiate total parenteral nutrition
C Place gastrostomy tube
D Seek intervention from a court-appointed guardian
After her neurologic examination, the patient's family is told that her clinical signs and symptoms are likely indicative of an impending persistent vegetative state. Her entire family, including her husband who is her formally designated health care proxy, recall numerous conversations with the patient in which she expressed the desire for life-prolonging efforts, assuming there were a reasonable possibility of recovery allowing her to interact with her family; however, she rejected the prospect of life-sustaining measures if it were determined with reasonable medical certainty that she was going to be in a permanently unconscious state. Family members resist placement of a gastrostomy tube because they worry that once this type of support is initiated, it cannot legally be discontinued; however, they understand that it would provide optimal access for medications, nutrition, and fluids.
Which of the following is the most appropriate recommendation for this patient's family?
A Continue nasogastric tube feedings
B Initiate total parenteral nutrition
C Place gastrostomy tube
D Seek intervention from a court-appointed guardian