Question

Patient has Stevens-Johnson syndrome with uncertain prognosis (50/50 chance). Patient arrests, is unconscious vented and needs dopamine to maintain her blood pressure constantly. Patient disclosed to family and nurse prior to arrest that she does not wish to be kept alive should she become a "vegetable". She also has an advanced care directive stating that should she become terminal, she does not wish for life sustaining measures. Nurse says to doctor that perhaps we should discontinue treatment in accordance with patient and family wishes. Doctor says no. nurse hangs a bag of normal saline, labels it dopamine, patient arrests and dies. Was this ethical?

1. Discuss any Federal &/or State laws (California) that apply?

Answer 1

Yes it is ethical, if patient or patient relatives does not wish for life sustaining measures.

1.Discuss any Federal &/or State laws (California) that apply?

There are many advance directive formats. Some follow forms outlined in state laws, others are created by lawyers or even the patients themselves. All states and the District of California have laws about advance directives. Be sure to know specific requirements of writing legal advance directives in health care system.

The most common types of advance directives are

▪ The living will

▪ The durable power of attorney for health care

▪ Do not Resuscitate (DNR) orders

▪ POLST (Physician Orders for Life-Sustaining Treatment

The living will

The living will is a legal document used for future health care decisions only when a person becomes unable to make the decisions and choices on their own. The living will is only used at the end of life if a person is terminally ill (can't be cured) or permanently unconscious. The living will describes the type of medical treatment the person would want or not want to receive in these situations.

Living will laws vary from state to state. Be sure to know your specific state laws.

Durable power of attorney for health care/Medical power of attorney

A durable power of attorney for health care, also known as a medical power of attorney, is a legal document where patient name a person to be a proxy (agent) to make all his/her health care decisions if become unable to do so.

If regain the ability to make his /her own medical decisions, proxy (agent) can't continue to make medical decisions on behalf.

Do_not _Resuscitate

A Do Not Resuscitate or DNR order means that if stop breathing or heart stops, nothing will be done to try to keep alive. If he /she is in the hospital, relative can ask doctor to add a DNR order to medical record.

POLST (Physician Orders for Life-Sustaining Treatment)

A POLST form also helps express patient wishes for health care, but it is not an advance directive. A POLST form has a set of specific medical orders that a seriously ill person can fill in and ask their health care provider to sign. A POLST form addresses patient wishes in an emergency, such as whether to use CPR (cardiopulmonary resuscitation) in an emergency, or whether to go to a hospital in an emergency and be put on a breathing machine if necessary, or stay where you are and be made comfortable.

Many individuals at the end of life are unable to convey their wishes regarding medical treatments. Advance directives (ADs) allow them to crystallise their wishes in a written form so that these can be carried out if the relevant situation arises.