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  #1  
Old 05-19-2010
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Medicolegal and Ethics Daughter wants to stop ventilation of her mom?

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 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.
What is the best course of action?
(A) Discuss with the daughter her reasons for withdrawing care
(B) Maintain current management based on the patientís prognosis
(C) Obtain a court order mandating continuation of ventilatory support
(D) Obtain an ethics consultation
(E) Withdraw ventilatory support based on the daughterís power of attorney
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  #2  
Old 08-01-2011
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E: Durable power of attorney takes over the living will. as the lady here is not able to make decision.
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  #3  
Old 08-01-2011
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I think answer is A......first discuss why she want to withdraw then next step after A should be D...
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  #4  
Old 08-03-2011
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i think A just for to find out reasoning...but current living will trumps all when she was coherent to make a decision...SO even if the daughter wants she cant remove it.
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  #5  
Old 08-03-2011
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i think its A
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  #6  
Old 08-03-2011
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i think it is A
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  #7  
Old 08-03-2011
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Quote:
Originally Posted by RRMadukha View Post
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 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.
What is the best course of action?
(A) Discuss with the daughter her reasons for withdrawing care
(B) Maintain current management based on the patientís prognosis
(C) Obtain a court order mandating continuation of ventilatory support
(D) Obtain an ethics consultation
(E) Withdraw ventilatory support based on the daughterís power of attorney
I think its A, the woman needs to be fully informed about the current situation before making a decision and we need to understand that the patient(or proxy) is understanding everything.

... hope i got this right.
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  #8  
Old 08-03-2011
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i would go wid A). anyways POA loses its sinificance when we have a living will on board..
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  #9  
Old 08-04-2011
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Thumbs Up Rule# 07 Solve the problem presented

"A"

Here applies rule 7, solve the problem presented.

Look for solution not the answer.
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  #10  
Old 08-04-2011
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A .discuss w/daughter reason for..
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  #11  
Old 03-16-2012
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A...it is always good to know what the reasons are, then worse case scenario have an ethics consultation.
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