WBR0329

Author	[[PageAuthor::Yazan Daaboul, M.D. (Reviewed by Serge Korjian and (Reviewed by Alison Leibowitz))]]
Exam Type	ExamType::USMLE Step 1
Main Category	MainCategory::Ethics
Sub Category	SubCategory::General Principles
Prompt	[[Prompt::An unconscious 67-year-old man, with no advanced directive, is brought to the emergency department by EMS. Following appropriate work-up, the patient is diagnosed with an ischemic stroke and is admitted for appropriate management. After several days, the physician in charge informs the family that the patient is in a persistent vegetative state supported by machines. The patient has no attorney and has no court-appointed legal guardian. When informed, the patient's family members start to discuss among themselves the possibility of taking the patient off life support. The family members fail to reach a unanimous decision. Which of the following is the most appropriate way to proceed with this patient's case?]]
Answer A	AnswerA::The physician in charge must adhere to the decision of the patient's wife
Answer A Explanation	AnswerAExp::The patient's wife comes first in priority to be the his health care surrogate.
Answer B	AnswerB::The physician in charge must adhere to the decision of the patient's adult children
Answer B Explanation	AnswerBExp::The decision of the patient's children are considered when the patient's wife is not present or is not a candidate to make decisions.
Answer C	AnswerC::The physician must ask the court of law to decide whether the patient should be off life support or not.
Answer C Explanation	AnswerCExp::There is no need at this point to request from the court of law to make decisions for or against life-sustaining medical interventions.
Answer D	AnswerD::The physician must adhere to the decision of the patient's primary care physician.
Answer D Explanation	AnswerDExp::Caring physicians of the patient have no role in deciding for or against life-sustaining medical interventions.
Answer E	AnswerE::The physician must ask if the patient has any surviving parents whose decision must be adhered to.
Answer E Explanation	AnswerEExp::The patient's parents are considered priority only when the patient is a minor.
Right Answer	RightAnswer::A
Explanation	[[Explanation::When unconscious patients with no advance directives are hospitalized and require a surrogate decision-maker for life-sustaining medical interventions, the following order of priority for health care surrogates must be taken into account: 1- Patient's guardian 2- Patient's spouse 3- Patient's adult son or daughter 4- Patient's parent 5- Patient's adult brother or sister 6- Patient's adult grandchild or adult relative who is familiar with the patient and has shown care and concern for the patient 7- Patient's close friend 8- Patient's guardian of the estate In this scenario, the patient cannot make his own decisions, so the patient's wife is considered his health care surrogate, and her decision must be adhered to by the caring physician. The case above does not reveal any reason why the wife would have a disabling condition, mental illness, or conflict of interest that would hinder her from being an appropriate health care surrogate. Educational Objective: A patient's spouse is considered the health care surrogate for adult patients who do not have any advanced directive. References: First Aid 2014 page 60]]
Approved	Approved::Yes
Keyword	WBRKeyword::life-sustaining, WBRKeyword::intervention, WBRKeyword::interventions, WBRKeyword::life support, WBRKeyword::proxy, WBRKeyword::medical, WBRKeyword::stroke, WBRKeyword::ischemic, WBRKeyword::vegetative state, WBRKeyword::ethics
Linked Question	Linked::
Order in Linked Questions	LinkedOrder::