Family Pleading for CPR but the living will states otherwise! - USMLE Forums
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  #1  
Old 07-17-2011
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Medicolegal and Ethics Family Pleading for CPR but the living will states otherwise!

A 68 yrs old man is admitted to the hospital with acute onset of breathlessness. He is a known patient and a chronic smoker who has been treated for chronic obstructive pulmonary disease for many years. Vital signs include: temp 37.2, BP 132/70, pulse102, RR 24. Cyanosis and intercostal muscle recessions are evident on exam. ABGs are obtained and include a PH of 7.45, PO2 50, PCO2 of 60. Based on this information, it is concluded that the patient is in respiratory failure and will require mechanical ventilation. The man's medical charts include a living will that specifies he does not want any resuscitation or invasive therapies to be undertaken in an event of life threatening emergency. His family is present at his bedside and plead for the most aggressive measures possible to be undertaken in an effort to save his life. When the living will is mentioned, the family members threaten to file a lawsuit if CPR is not given. What to do next

1) Proceed with the CPR and place the patient on ventilator
2) Intubate the patient but do not place him on a ventilator
3) Discuss the situation with the family
4) Contact the hospital ethics committee
5) Obtain a court order authorizing CPR
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  #2  
Old 07-17-2011
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I think its 3 (Discuss it with family) ... the family cannot file a law suit if the patient asked not to intervene in case of life threatening condition. 1st two options are contradicting the patients will. and by the time the Court order permission for CPR, the patient may have expired ... so its best to discuss it with the family

Last edited by hammad86; 07-17-2011 at 02:47 AM. Reason: mistake..
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Old 07-17-2011
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i go with answer 1. the physician should not participate in a suicide.
the doctor i think must do all one can do to save a patient's life.
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  #4  
Old 07-17-2011
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Default the will wins !!

ok this question really confused me..i remember some one posted a similar question on this forum a few days back and the answer given at that time was that the physician should try everything short of a major intervention in order t osave the pt life even if the will says that no resuscitative measures to be taken .but in this question the correct answer is that the physician respect the pt's willanddiscuss it with the family.even if after the discussion the family insists then the physician can call the hospital committe to step in
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Old 07-17-2011
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4) contact ethics committee
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Old 07-17-2011
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Quote:
Originally Posted by ana11 View Post
i go with answer 1. the physician should not participate in a suicide.
the doctor i think must do all one can do to save a patient's life.
not administering CPR is not considered physician assisted suicide. You are just following the patients pre-stated wishes. Intubation is considered part of CPR. The best answer here is to discuss with the family.
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Old 07-17-2011
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Hi guys, if you have MTB-CK check page 564. For questions like this the best thing to do is usually to 'discuss' (there might be a few exceptions though). Its even highlighted as a TIP (if you are familiar with the book you'll know what I'm talking about).

So I'll go for the simple and reasonable option - DISCUSS

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If it helps click on thank you. If you dont agree with the option, lets discuss it further. We are all here to learn
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Old 07-18-2011
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The answer is 3. First u have to Discuss the situation with the family,
if no solution reached the family then u have to (answer 4) Contact the hospital ethics committee.
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Old 07-18-2011
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Your definitely going to discuss it with the family but no matter what they say your going to have to follow thru with the living wills statement.
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Old 07-19-2011
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I think the answer is 2. If that is the patient's will, the doctor can only provite supportive therapy.

The family may oppose, but it is the patient himself who has to decide what is the best for him. ( in this case his living will)
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