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[C59:1] A patient with quadriplegia is admitted with COVID. The patient requires admission to the ICU, but the attending practitioner says that the quality of the patient’s life does not warrant aggressive treatment. The patient’s family disagrees. What should be done?
[C59:3] Who has decisional authority?
[C59:4] Competent adults with decisional capacity have the legal and moral authority to accept or reject treatment options through the process of informed consent. Being a person with quadriplegia does not mean that the patient also lacks decisional capacity. Therefore, what the practitioner feels about quantity and quality of life, and whether or not the patient’s family agrees with the practitioner, is legally and morally irrelevant. Rather the patient has the right to authorize or reject the relevant treatment options, not the practitioner or family members.
[C59:5] If the patient were to lack decisional capacity, and if the family were to be the patient’s surrogate medical decision-makers, then they would legally and morally be obliged to make treatment decisions for the patient using substituted judgment, that is, by using the patient’s reasonable goals, values, and priorities for making treatment decisions, not their own. If the patient’s reasonable goals, values, and priorities are not determinable, then the surrogates are to make medical decisions based on what would maximize the patient’s best interests.
[C59:6] The practitioner has the professional obligation of beneficence (do good) and the professional obligation of nonmaleficence (do no harm) to provide treatment(s) that the patient has determined to be in their best interests not the practitioner. If the patient lacks decisional capacity, then the family would have the medical decision-making authority as long as the family uses substituted judgment. If the patient’s reasonable goals, values, and priorities are indeterminable, then the family should make medical decisions based on what would most likely be the patient’s best interests from the patient’s perspective.
The patient has the legal right to authorize or reject legitimate treatment options.
[C59:9] As a negative right, others have an obligation to not interfere in the patient’s treatment authorization, and as a positive right, others have an obligation to provide the authorized treatment options.
[C59:11] Practitioner should get informed consent from the patient, not the family members. The family would only have surrogate decision-making authority if the patient were not to have decisional capacity, and there were no oral or written directives, no living will, and no durable power of attorney specifying a specific proxy.
(Choice A) Do not admit the patient to the ICU because the practitioner has the authority to determine who gets admitted into the ICU and who does not.
(Choice B) Do not admit the patient to the ICU because the quality of life is more important than the quantity of life.
(Choice C) Let the courts decide.
(Choice D) Admit the patient to the ICU because the practitioner has the professional obligation always to promote the quantity of life.
(Choice E) Admit the patient to the ICU because the patient’s family has the decision-making authority.
(Choice F) The practitioner needs to get informed consent from the patient.
Obligation of others to Not Interfere
Obligation of others toProvide something