### Medical Ethics Case Study: Advance Directives and Family Wishes**Case:**A 24-year-old man with advanced AIDS develops severe Pneumocystis jiroveci (formerly P. carinii) pneumonia necessitating mechanical ventilation. The patient has signed an advance directive stating that he does not want to be placed on a ventilator. However, his family insists that mechanical ventilation be initiated. The physician needs to decide the most appropriate course of action.**Question:**Which of the following is the most appropriate action by the physician?**Options:**- A) Call the hospital attorney for advice- B) Comply with the family’s wishes and begin mechanical ventilation for the patient- C) Comply with the family’s wishes by trying to persuade the patient to accept mechanical ventilation- D) Comply with the patient’s original wishes as outlined in the advance directive- E) Start mechanical ventilation for the patient and consult the hospital ethics committee for advice on how to proceed**Explanation:**In this scenario, healthcare professionals must carefully weigh ethical considerations, legal directives, and patient autonomy. Advance directives are legal documents stating a patient's preferences for medical treatment if they are unable to make decisions for themselves. They form the basis of respecting patient autonomy even when family members have differing wishes.**Discussion Points for Educational Purposes:**1. **Advance Directives:** - Importance and implications in patient care. - How advance directives guide physicians in respecting patient autonomy.2. **Ethical Principles:** - Autonomy: Respecting the patient's wishes as legally documented. - Beneficence vs. Non-maleficence: Balancing the benefits and harm in treatment decisions. - Role of family input in patient care, especially when it conflicts with documented patient wishes.3. **Legal Considerations:** - The legal binding nature of advance directives. - Physician’s responsibilities in upholding patient directives.4. **Role of Ethics Committees:** - How and when to involve hospital ethics committees in resolving conflicts. - Procedures for consulting legal advisors in complex cases.### ConclusionThe most appropriate action is option D: **Comply with the patient’s original wishes as outlined in the advance directive.**This ensures that the patient's autonomy and legal rights are respected, providing ethically and legally sound medical care according to the patient's documented preferences.

An advance directive is a legal document prepared by the patient that suggests the patient's family,…

Answered: 54. A 24-year-old man with advanced…

Phlebotomy Essentials

6th Edition

ISBN:9781451194524

Author:Ruth McCall, Cathee M. Tankersley MT(ASCP)

Publisher:Ruth McCall, Cathee M. Tankersley MT(ASCP)

Chapter1: Phlebotomy: Past And Present And The Healthcare Setting

Section: Chapter Questions

Problem 1SRQ

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The emergency medical technicians have brought a 65-year-old patient in cardiac arrest. The patient had been ventilated with a manual resuscitator and mask. As yo attempt to ventilate, the patient vomits. A) What would be your immediate actions? B) During your next attempt to intubate, you observe a large piece of undigested steak blocking your view of the glottis. How would you clear the airway, and what equipment would be needed? C) After the airway is cleared, you attempt to intubate the patient. However, your ability to intubate is impeded by the movement of the chest compressions. What would you suggest?
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187. A previously healthy 59-year-old man comes to the emergency department because of a 1-day history of fever, shortness of breath, and productive cough. He appears to be in moderate distress. His temperature is 38.4°C (101.1°F), and respirations are 26/min. Pulse oximetry on room air shows an oxygen saturation of 88%. Bronchial breath sounds are heard over the right lung base posteriorly with egophony and increased tactile fremitus. A chest x-ray shows right lower lobe pneumonia. Which of the following mechanisms is the most likely cause of the hypoxia in this patient? A) Alveolar fibrosis B) Hypoventilation C) Right-to-left cardiac shunt D) Right ventricular failure E) Ventilation-perfusion mismatch 27
You are assisting the care of a pcardiac arrest patient. Your partner is BVM. You can see there is no chest rise in ventilations. Which of the following should you chose next to improve the situation? A) Attatch oxygen flow to the BVM B) Evaluate the patient for Pnemothorax C) Evaluate the patient for airway obstruction D) Assist partner to maintain a seal on the BVM

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