Review Question - QID 109080

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Legal Principles End-of-Life Issues If the patient cannot make decisions, surrogate decision makers must use the following criteria: QID: 109080 (M1.ST.17.4768)

QID 109080 (Type "109080" in App Search)

A 76-year-old man is brought to the hospital after having a stroke. Head CT is done in the emergency department and shows intracranial hemorrhage. Upon arrival to the ED he is verbally non-responsive and withdraws only to pain. He does not open his eyes. He is transferred to the medical ICU for further management and intubated for airway protection. During his second day in the ICU, his blood pressure is measured as 91/54 mmHg and pulse is 120/min. He is given fluids and antibiotics, but he progresses to renal failure and his mental status deteriorates. The physicians in the ICU ask the patient’s family what his wishes are for end-of-life care. His wife tells the team that she is durable power of attorney for the patient and provides appropriate documentation. She mentions that he did not have a living will, but she believes that he would want care withdrawn in this situation, and therefore asks the team to withdraw care at this point. The patient’s daughter vehemently disagrees and believes it is in the best interest of her father, the patient, to continue all care. Based on this information, what is the best course of action for the physician team?

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Listen to the patient’s wife’s wishes and withdraw care

85%

35/41

Listen to the patient’s daughter’s wishes and continue all care

0/41

Compromise between the wife and daughter and withdraw the fluids and antibiotics but keep the patient intubated

0/41

Consult the hospital ethics committee and continue all care until a decision is reached

2/41

Call other family members and consult them for their opinions

0/41

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This patient has had an ICU course because of a hemorrhagic stroke complicated by sepsis and is unfortunately in a state where end-of-life care must be considered. The patient’s wife is the power of attorney and her wishes must be respected, even if in conflict with the wishes of other members of the family.

A power of attorney is a process by which the patient designates a healthcare proxy that can make all decisions for the patient. The power of attorney supersedes a living will and “best interest” considerations of other family members/individuals if this is in conflict.

Incorrect Answers:
Answer 2: Though the daughter may have the best interests of the patient in mind, a power of attorney as declared by the patient supersedes her wishes.

Answer 3: This would be inappropriate as the patient has legally declared his wife as power of attorney.

Answer 4: The hospital ethics committee is unnecessary in this situation as the patient has clearly identified a power of attorney with the appropriate documentation.

Answer 5: This would be inappropriate – the wife’s wishes should be followed because she is the power of attorney.

Bullet Summary:
A power of attorney is a process by which the patient designates a healthcare proxy that can make all decisions for the patient, and such decisions supersede a living will and “best interest” considerations of other family members if this is in conflict.

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