A 72-year-old Caucasian man is brought to the emergency department (ED) due to a sudden onset of severe difficulty in breathing. He has chronic obstructive pulmonary disease, and is on 2 liters of oxygen at all times. While in the ED, he develops progressive hypoxic respiratory failure, and is intubated by the ED physician. His son comes to the hospital an hour later, and gets very upset. He pulls you to one side of the room and says, "Please remove the tube. He never wanted to live like this." The patient does not have any advance directives for his health care. He regains consciousness for a few seconds while you were having a discussion with his son, but he was unable to state his wishes regarding life-sustaining treatment.
The patient's whole family shows up in the hospital two hours later. He has two sons and three daughters who appear extremely concerned by the recent events. They all live in the same town and are very close to their parents. The patient lives alone. After prolonged discussions, the two sons agree and wish to proceed with the withdrawal of mechanical ventilation. The daughters are adamant about continuing life-sustaining treatment. The daughters tell you, "Our dad never said that he didn't want to live". Which of the following is the most appropriate next step in the management of this patient?

Question

A 72-year-old Caucasian man is brought to the emergency department (ED) due to a sudden onset of severe difficulty in breathing.  He has chronic obstructive pulmonary disease, and is on 2 liters of oxygen at all times. While in the ED, he develops progressive hypoxic respiratory failure, and is intubated by the ED physician.  His son comes to the hospital an hour later, and gets very upset.  He pulls you to one side of the room and says, "Please remove the tube.  He never wanted to live like this."  The patient does not have any advance directives for his health care.  He regains consciousness for a few seconds while you were having a discussion with his son, but he was unable to state his wishes regarding life-sustaining treatment.
The patient's whole family shows up in the hospital two hours later.  He has two sons and three daughters who appear extremely concerned by the recent events.  They all live in the same town and are very close to their parents.  The patient lives alone.  After prolonged discussions, the two sons agree and wish to proceed with the withdrawal of mechanical ventilation.  The daughters are adamant about continuing life-sustaining treatment.  The daughters tell you, "Our dad never said that he didn't want to live".  Which of the following is the most appropriate next step in the management of this patient?

Quizplus · Accepted Answer

Explanation: Quite frequently, a physician is faced with a situation wherein multiple first-degree relatives cannot agree on the approach to medical care, despite appropriate and adequate counseling. In such cases of conflict, the hospital's ethics committee should be involved to act as a mediator between the different family members. In extreme cases, the case may need to be taken to court, where a guardian is appointed to assist in the medical decision-making. (Choices A, B, and C) All the family members should be involved in the decision-making process regarding the withdrawal of mechanical ventilation. Educational Objective: The hospital ethics committee should be involved if a conflict exists between multiple family members regarding the appropriate approach to the patient's medical care despite adequate mediation by the physician.

A 72-Year-Old Caucasian Man Is Brought to the Emergency Department (ED) Due