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Old 01-13-2010
DrSeddik's Avatar
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Medicolegal and Ethics Autonomy related questions

I just thought of these scenarios, I don't know if they can come up on the exam, I am also not sure of their answer.

- A child with Down and severe pneumonia and heart failure. Parents don't want you to treat.

- A patient who is in a persistant vegetative state is known to say that he wouldn't want to live like that, but his friend who is has durable power of attorney tells you to give maximal medical care.
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Old 01-13-2010
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--For the child, I think you have to do your best to convince the parents of the importance of treatment and if they still insist on no treatment then you don't listen to them if it is immediately life saving.
If it is not an emergence this hour then you can obtain a court order.

--For that patient then I think you have to listen to the patient as long as he's competent only if he's incompetent you listen to the surrogate.

This is what I think, let's what others would say about it
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Old 01-14-2010
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The thing with Down babies is that they may have bad prognoses, any adult patient with bad prognosis can choose not to be treated, and it might be the best thing to do for him in many logic conceptions. This is between keeping life, or the ability to refuse treatment for logic reason, not just parents who wouldn't want their son to be treated because of personal believes or ignorance. I would have chosen not to treat, but I am also not sure.

In the second case the patient is in a coma, but when he was concious he was known to say that he would not like to have medical care in this state, but did not make a living will, and his serrogate wants you to treat. I agree with you but I am not sure either.
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Old 01-14-2010
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For the down patient, you have to treat because this is not like the abortion option where you can choose not have the baby.
The baby is there and there's a good chance that he can lead a reasonable life.

For the second case, how did you know that patient doesn't want to live in a vegatitive state? if he wrote a will then you do what the will said otherwise listen to the surrogate.
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Old 01-14-2010
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Quote:
Originally Posted by YoramFishke View Post
For the down patient, you have to treat because this is not like the abortion option where you can choose not have the baby.
The baby is there and there's a good chance that he can lead a reasonable life.

For the second case, how did you know that patient doesn't want to live in a vegatitive state? if he wrote a will then you do what the will said otherwise listen to the surrogate.
- In the case of the child, I meant by having severe heart failure and pneumonia that his prognosis is poor, a better example would be DIC or septic shock with end organ damage.

- I faced few questions where they say that for example patient's wife says that he said he wants to get medical service, but she (being his next of kin), doesn't want him to do so. In this case the answer would be to give medical service according to what the patient would have wished, but what would you do if the wife was his surrogate.

I know I am being toooo paranoid here, but I am allowed "Pre-exam Tension Syndrome"
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Old 01-14-2010
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Quote:
Originally Posted by DrSeddik View Post
- In the case of the child, I meant by having severe heart failure and pneumonia that his prognosis is poor, a better example would be DIC or septic shock with end organ damage.

- I faced few questions where they say that for example patient's wife says that he said he wants to get medical service, but she (being his next of kin), doesn't want him to do so. In this case the answer would be to give medical service according to what the patient would have wished, but what would you do if the wife was his surrogate.

I know I am being toooo paranoid here, but I am allowed "Pre-exam Tension Syndrome"
The surrogate speaks with the patient voice. They will ask her what would your husband decide if he was conscious. They will not ask her what is your opinion or decision.
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