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Old 07-06-2011
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Medicolegal and Ethics Living Will States "Die in peace"!

68 y/o patient with terminal metastaic breast cancer lives home with her husband. She has a living will stating that she wants to "die in peace". She is unresponsive to voice and has not had any fluid or food in last 3 days. Husband disagrees with her decision to refuse medication, chemotherapy, enteral or parenteral nutrition and wants you to interfere.
What is the most appropriate step in management?
a) Abide the decision of the next of kin
b) Obtain court order to allow additional therapy
c) Start enteral feeding
d) Admit her to the hospital
e) No further intervention
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Old 07-06-2011
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e
No further intervention
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Old 07-06-2011
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Default E

I would say E) No further intervention required.

However, breast cancer is the second most common metastatic tumor to the brain (first is lung cancer & third is melanoma). The question does not say anything about her being incompetent or brain metastasis so as long as her living will was made when she was competent - you have to respect the patients decision and follow it.
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E. no further intervention
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Old 07-06-2011
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E-no intervention
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Old 07-06-2011
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E sounds like an obvious answer but what exactly does 'die in peace mean' ? In my opinion, its almost as good as nothing
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Old 07-07-2011
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Living will The living will is the most widely used written advance directive The typical will takes effect if the person is terminally ill with no chance of recovery, and outlines the desire to withhold heroic measures.
Living wills give a general sense of the patient's wishes, and can be modified to include specific interventions such as cardiopulmonary resuscitation, ventilatory support, or enteral feeding. However, they are limited by their vagueness.
this is from uptodate

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