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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
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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
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A living will shows that she has agreed to intubation and resuscitation if necessary.
B?
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I thought B too...because a living will is superior... I think...
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I think b because living will is there but just talking over the phone cant be trusted although
health power of attorney beats all
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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
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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
