An 84-year-old woman is admitted with abdominal pain. On the...

An 84-year-old woman is admitted with abdominal pain. On the second hospital day she becomes febrile, severely hypotensive, and tachycardic from an intestinal perforation. The patient is disoriented with no capacity to understand her medical problems. There is no response to antibiotics, fluids, and dopamine over the next 48 hours and there are signs of significant anoxic encephalopathy. Although there is no health-care proxy, the family is in uniform agreement on what the patient would have wanted for herself had she been able to speak for herself. Which of the following cannot be stopped at the direction of the family? a. Ventilator b. Blood tests c. Dopamine d. Fluid and nutrition e. Nothing

An 84-year-old woman is admitted with abdominal pain. On the second hospital day she becomes febrile, severely hypotensive, and tachycardic from an intestinal perforation. The patient is disoriented with no capacity to understand her medical problems. There is no response to antibiotics, fluids, and dopamine over the next 48 hours and there are signs of significant anoxic encephalopathy. Although there is no health-care proxy, the family is in uniform agreement on what the patient would have wanted for herself had she been able to speak for herself.
Which of the following cannot be stopped at the direction of the family?
a. Ventilator
b. Blood tests
c. Dopamine
d. Fluid and nutrition
e. Nothing

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Key Concepts

Artificial Nutrition and Hydration as Basic Care

Distinct from other medical treatments, artificial nutrition and hydration are often regarded as basic care rather than extraordinary treatment. Ethically and legally, many guidelines treat them as essential sustenance, meaning that even in the context of withdrawing other life-sustaining measures, these basic interventions should generally continue because they address fundamental human needs.

Substitute Decision Making

This concept refers to the process by which a family member or legally designated surrogate makes healthcare decisions on behalf of a patient who is unable to express their own wishes. The substitute decision maker is expected to use either the patient’s previously stated wishes (substituted judgment) or, if those are not known, to decide based on what is in the patient’s best interests.

Withdrawal of Life-Sustaining Treatment

This term encompasses the ethical and legal principles that allow clinicians and substitute decision makers to discontinue medical interventions that are considered extraordinary or non-beneficial. Interventions such as mechanical ventilation or certain medications may be withdrawn if they are deemed to prolong suffering or if they no longer contribute to the patient’s well-being as per the patient’s wishes or values.

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