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  #1  
Old 04-26-2012
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Medicolegal and Ethics Patient wants to remove the ventilator?

A 33 year old female boxer sustains a cervical spine fracture during the welterweight championship match in Las Vegas. She has a fracture of C1 and C2 resulting in paralysis from the neck down and is ventilator dependent. She is fully alert and understands her medical condition. Her manager is the health-care proxy. She is frustrated but not depressed and is repeatedly and clearly requesting removal from the ventilator. She understands that she will not survive without the ventilator. What should you do?

A) Remove the ventilator as she requests.
B) Obtain a court order to continue the ventilator.
C) Seek family consensus on removing the ventilator.
D) Seek approval of the health care proxy.
E) Sedate the patient and continue the ventilator.

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Bonus question - Where else might have you seen this case before?
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Old 04-26-2012
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A) remove it...

oh this Las Vegas... I miss it a lot... you either fly high or fall down as this poor lady...
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Old 04-26-2012
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D. Seek for health care proxy.
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Old 04-26-2012
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Originally Posted by Hope2Pass View Post

Bonus question - Where else might have you seen this case before?
"Million dollar baby"
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A

remove the ventilator
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Assume the patient is competent unless you can see any information in the question that shows otherwise, in this case the patient is competent so speaking with other people for approval is not needed. Avoid going to court.
sedating the patient and keeping the ventilator is against her will so it's wrong as well.
you only got answer A as right - respect the patients autonomy over her body.
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Originally Posted by Dr. Mexito View Post
"Million dollar baby"
Yes! Thank you, finally someone knows what its about

And you guys are correct. The answer is A) Remove the Ventilator. As 'modesty' explained, the patient in the question stem is competent and there is no need to talk to the health proxy in this case. The patient's directives are quite clear. You don't need to discuss with the family or take it to the court either coz these are done when the patient is incompetent or unable to communicate with no living will, advance directive or health proxy. In this case, the patient understands everything and is competent to make a decision for herself.
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Yes! Thank you, finally someone knows what its about

And you guys are correct. The answer is A) Remove the Ventilator. As 'modesty' explained, the patient in the question stem is competent and there is no need to talk to the health proxy in this case. The patient's directives are quite clear. You don't need to discuss with the family or take it to the court either coz these are done when the patient is incompetent or unable to communicate with no living will, advance directive or health proxy. In this case, the patient understands everything and is competent to make a decision for herself.

isn't its kind of assisting in suicide
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isn't its kind of assisting in suicide
Thanks for bringing that up. No this is not a form of euthanasia or physician assisted suicide.

Physician assisted suicide - supplying the patient with something that he can take himself to die ...ex- a prescription for a medicine or some pills etc.

Euthanasia - supplying the patient with something that would cause death and giving it to him by yourself as a doctor ... ex - an injection etc.


In the question above, the patient is fully competent, understands the benefits and risks of removing the ventilator and then makes a decision on what she wants to do further. Its solely her decision on what to do with her own body. There is no limitation on what can be removed or withheld as a form of treatment - IV's, nasogastric tubes, ventilators, drugs, anything ... the PATIENT DECIDES (as long as the patient is competent, communicative and understands the risks). The question stem clearly states shes fully aware, shes not depressed. Had the question stated that shes depressed and has suicidal ideation then you would go to the health care proxy.

BUT this question is in no means referring to euthanasia or physician assisted suicide .. you're just doing what the patient wants you to do because she has the right to decide for herself.
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Originally Posted by Hope2Pass View Post
Thanks for bringing that up. No this is not a form of euthanasia or physician assisted suicide.

Physician assisted suicide - supplying the patient with something that he can take himself to die ...ex- a prescription for a medicine or some pills etc.

Euthanasia - supplying the patient with something that would cause death and giving it to him by yourself as a doctor ... ex - an injection etc.


In the question above, the patient is fully competent, understands the benefits and risks of removing the ventilator and then makes a decision on what she wants to do further. Its solely her decision on what to do with her own body. There is no limitation on what can be removed or withheld as a form of treatment - IV's, nasogastric tubes, ventilators, drugs, anything ... the PATIENT DECIDES (as long as the patient is competent, communicative and understands the risks). The question stem clearly states shes fully aware, shes not depressed. Had the question stated that shes depressed and has suicidal ideation then you would go to the health care proxy.

BUT this question is in no means referring to euthanasia or physician assisted suicide .. you're just doing what the patient wants you to do because she has the right to decide for herself.
Thanks for the time and explainin.
i would have marked it to remove also, but these are type of questions that we should be keep on reinforcing otherwise we start to choose answer in more human ways
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Thanks for the time and explainin.
i would have marked it to remove also, but these are type of questions that we should be keep on reinforcing otherwise we start to choose answer in more human ways

yeah .. try reading 100 cases of medical ethics. Its by Kaplan but written by Conrad Fischer. Its very helpful.
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yeah .. try reading 100 cases of medical ethics. Its by Kaplan but written by Conrad Fischer. Its very helpful.
this is in my to do list
but what you suggest a second read of kaplan BS or medical ethics , also how much time it will take , or lets say number of hours ?
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this is in my to do list
but what you suggest a second read of kaplan BS or medical ethics , also how much time it will take , or lets say number of hours ?
100 Fischers will take u 1-2 days. But its pure "Ethics" in KLN u see more stuff. Id recommend both though
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yeah in kaplan you can do biostats, epi, child milestones, psych etc. 100 cases is just ethics. Its your call and depends on how much time you want to spend on it.
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yeah in kaplan you can do biostats, epi, child milestones, psych etc. 100 cases is just ethics. Its your call and depends on how much time you want to spend on it.
if its 1-2 days than i easily chunk it in , thx
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