WBR0329

Author	[[PageAuthor::Rim Halaby, M.D. [1]]]
Exam Type	ExamType::USMLE Step 1
Main Category	MainCategory::Ethics
Sub Category	SubCategory::General Principles
Prompt	[[Prompt::A 67 year old man with no advanced directive is brought unconscious to the emergency department. Following appropriate work-up, he is diagnosed with an ischemic stroke. After several days in the hospital, the physician in charge informs the family that the patient is in a persistent vegetative state and is supported by machines. The patient has no attorney and has no court-appointed legal guardian. When informed, the patient's members family start to discuss among themselves the possibility of taking the patient off life support. Although his wife asks the patient is taken off life support, his 27 year old daughter and his 25 year old son do not wish to end his life. What is the most appropriate approach to 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 daughter and son.
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 to ask the court of law to take decisions.
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 in favor 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 when the patient is a minor, which is not the case.
Right Answer	RightAnswer::A
Explanation	[[Explanation::When patients with no advance directives are brought in unconscious states 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 case, the patient cannot make his own decisions. As such, 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 wouldn't make her a good candidate of being an appropriate health care surrogate. Educational Objective: The medical team selects a patient's spouse as health care surrogates for adult patients who do not have any advanced directive. Educational Objective: References: ]]
Approved	Approved::No
Keyword	WBRKeyword::life, WBRKeyword::sustaining, WBRKeyword::life-sustaining, WBRKeyword::intervention, WBRKeyword::interventions, WBRKeyword::life, WBRKeyword::support, WBRKeyword::wife, WBRKeyword::spouse, WBRKeyword::daughter, WBRKeyword::son, WBRKeyword::children, WBRKeyword::guardian, WBRKeyword::child, WBRKeyword::advanced, WBRKeyword::directive, WBRKeyword::health, WBRKeyword::care, WBRKeyword::surrogate, WBRKeyword::proxy, WBRKeyword::medical, WBRKeyword::stroke, WBRKeyword::ischemic, WBRKeyword::vegetative, WBRKeyword::state, WBRKeyword::decision, WBRKeyword::making, WBRKeyword::decide
Linked Question	Linked::
Order in Linked Questions	LinkedOrder::