03-29-2009, 06:46 PM
A 42-year-old Caucasian man comes to the office for a follow-up visit. He was evaluated one week ago because of recurrent right upper quadrant abdominal pain, which usually occurs after eating fatty meals. He has no other medical problems. He does not use tobacco, alcohol or drugs. His family history is not significant. He does not have any medications. Physical examination shows no abnormalities. Abdominal ultrasound was performed after the previous visit, and this reveals the presence of two middle-sized gallstones in the patient's gallbladder, without compromise of the bile ducts and no intrahepatic lesions. He is advised to undergo laparoscopic cholecystectomy. He agrees to have the procedure, but states one condition: if something goes wrong with the surgery and he has cardiorespiratory arrest or fatal arrhythmia, he does not want to be resuscitated or receive electric shocks for cardioversion. Despite a prolonged discussion about his decision, he does not change his mind. He decides to write an advance directive before surgery. Which of the following is the most appropriate course of action?
A.
Postpone surgery, withdraw from the patient's care and refer him to another specialist
B.
Proceed with surgery, request the patient to sign a written agreement and continue his follow up
C.
Proceed with surgery, request the patient to sign advance directives and continue his follow up
D.
Refer the patient to a psychiatrist prior to surgery
E.
Postpone surgery and call the closest relative. Ask him/her to advice the patient and make him change his mind
A.
Postpone surgery, withdraw from the patient's care and refer him to another specialist
B.
Proceed with surgery, request the patient to sign a written agreement and continue his follow up
C.
Proceed with surgery, request the patient to sign advance directives and continue his follow up
D.
Refer the patient to a psychiatrist prior to surgery
E.
Postpone surgery and call the closest relative. Ask him/her to advice the patient and make him change his mind