A 5-year-old child is brought to the emergency department after being hit by a motor vehicle on the way to school. According to paramedics, the child's right leg was severely crushed in the accident. After evaluation, the physician recommends immediate limb-saving surgery to preserve the leg and prevent complications. However, the parents refuse to consent to the surgery. They explain that they heard about a similar case where a child died after limb-saving surgery, and they believe the procedure might lead to amputation or death. Despite the physician's explanation that the surgery is intended to save the limb, the parents remain adamant in their refusal. What is the next best step?
AContact the next of kin
BAsk for a court order
CTake into account the child’s wishes
DTake the parents' wishes into account
EInform the hospital Ethics Committee, state authority, and child protective services, and obtain a court order to proceed with treatment
A 76-year-old man is brought to the hospital after having a stroke. Head CT is done in the emergency department and shows intracranial hemorrhage. Upon arrival to the ED he is verbally non-responsive and withdraws only to pain. He does not open his eyes. He is transferred to the medical ICU for further management and intubated for airway protection. During his second day in the ICU, his blood pressure is measured as 91/54 mmHg and pulse is 120/min. He is given fluids and antibiotics, but he progresses to renal failure and his mental status deteriorates. The physicians in the ICU ask the patient’s family what his wishes are for end-of-life care. His wife tells the team that she is durable power of attorney for the patient and provides appropriate documentation. She mentions that he did not have a living will, but she believes that he would want care withdrawn in this situation, and therefore asks the team to withdraw care at this point. The patient’s daughter vehemently disagrees and believes it is in the best interest of her father, the patient, to continue all care. Based on this information, what is the best course of action for the physician team?
ACall other family members and consult them for their opinions
BListen to the patient’s daughter’s wishes and continue all care
CCompromise between the wife and daughter and withdraw the fluids and antibiotics but keep the patient intubated
DListen to the patient’s wife’s wishes and withdraw care
EConsult the hospital ethics committee and continue all care until a decision is reached
A 22-year-old man is brought to the emergency department by his friends 30 minutes after falling down a flight of stairs. His friends report that they were at a college party, where he drank large amounts of alcohol. He is aggressive and restless. Examination shows tenderness to palpation and swelling of his right lower leg. An x-ray of the right leg shows a lower tibial shaft fracture. The physician recommends overnight observation and surgery the following morning. The patient refuses the suggested treatment and requests immediate discharge. Otherwise, he says, he will call his lawyer and sue the entire medical staff involved in his care. Which of the following is the most appropriate response by the physician?
AYou can leave the hospital after signing a self-discharge against medical advice form.
BIf you don't consent to treatment, I'll be forced to obtain consent from your parents.
CI understand that you want to go home, but I'll have to keep you here as long as you are intoxicated.
DHave you ever felt you should cut down on your drinking?
EI can't force you to stay here, but I'll have to inform your dean of this incident.
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