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Old 09-17-2012
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Default psychiatry question

A 75-year-old man is in a persistent vegetative
state following a large intracranial bleed secondary
to an arteriovenous malformation. Two
advance directives are in the chart. One is a
living will stating that the patient requests withdrawal
of life-sustaining treatment if he were to
ever be in a vegetative state. The other is a durable
power of attorney form stating that his
brother is the legally designated surrogate
health care decision maker. After reading these
forms, the brother approaches the physician
and requests that the medical team continue to
treat, feed, and hydrate the patient. How
should the medical team proceed?

(A) Medical team should consult the hospital
ethics committee
(B) Medical team should continue to feed and
hydrate the patient but not provide additional
care (e.g., antibiotics if the patient
develops an infection)
(C) Medical team should continue to treat,
feed, and hydrate the patient
(D) Medical team should let a court decide
how to proceed
(E) Medical team should seek out the opinion
of the next closest family member to resolve
the issue
(F) Medical team should withdraw all treatment
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Old 09-17-2012
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F.....living will is superior to health power of attorney......
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Old 09-17-2012
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Quote:
Originally Posted by K06100 View Post
A 75-year-old man is in a persistent vegetative
state following a large intracranial bleed secondary
to an arteriovenous malformation. Two
advance directives are in the chart. One is a
living will stating that the patient requests withdrawal
of life-sustaining treatment if he were to
ever be in a vegetative state. The other is a durable
power of attorney form stating that his
brother is the legally designated surrogate
health care decision maker. After reading these
forms, the brother approaches the physician
and requests that the medical team continue to
treat, feed, and hydrate the patient. How
should the medical team proceed?

(A) Medical team should consult the hospital
ethics committee
(B) Medical team should continue to feed and
hydrate the patient but not provide additional
care (e.g., antibiotics if the patient
develops an infection)
(C) Medical team should continue to treat,
feed, and hydrate the patient
(D) Medical team should let a court decide
how to proceed
(E) Medical team should seek out the opinion
of the next closest family member to resolve
the issue
(F) Medical team should withdraw all treatment
Yes F, living will is superior to other advance directive.
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Old 09-17-2012
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Would go with F


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Old 09-18-2012
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The correct answer is F. A living will is a legal
document written by the patient dictating the
patient’s wishes about withholding or withdrawing
life-sustaining treatment in the event of a
terminal disease or a persistent vegetative state.
In this case, the patient meets criteria for persistent
vegetative state and therefore the medical
team should follow the patient’s written request
and withdraw life-sustaining treatment. If
the living will were not present, the surrogate
health care decision maker would have had authority
to dictate how to proceed with treatment.
Although surrogates should typically
make decisions consistent with the stated
wishes of the patient, this case highlights the
importance of patients making their wishes
known in a format such as the living will.
Answer A is incorrect. The hospital ethics
committee does not need to be consulted because
the living will clearly states the appropriate
course of action for the given clinical situation.
Answer B is incorrect. According to the living
will, all life-sustaining treatment should be
withdrawn.
Answer C is incorrect.In this case, the patient
meets criteria for persistent vegetative
state and therefore the medical team should
follow the patient’s written request and withdraw
life-sustaining treatment.
Answer D is incorrect. The court does not
need to be involved because the living will
clearly states the appropriate course of action
for the given clinical situation.
Answer E is incorrect. Although a close family
member should be consulted for decision making
if a living will or designated health care
proxy is not present, both are available and the
living will in this case dictates care.
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