Palliative surgical proceduresDownloads

A 53-year-old woman comes to the emergency department because of weakness and abdominal pain for 24 hours. She has had three bowel movements with dark stool during this period. She has not had vomiting and has never had such episodes in the past. She underwent a tubal ligation 15 years ago. She has chronic lower extremity lymphedema, osteoarthritis, and type 2 diabetes mellitus. Her father died of colon cancer at the age of 72 years. Current medications include metformin, naproxen, and calcium with vitamin D3. She had a screening colonoscopy at 50 years of age which was normal. She appears pale and diaphoretic. Her temperature is 36°C (96.8°F), pulse is 110/min, respirations are 20/min, and blood pressure is 90/50 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 98%. The abdomen is soft and nondistended with mild epigastric tenderness. Rectal exam shows tarry stool. Two large bore IV lines are placed and fluid resuscitation with normal saline is initiated. Which of the following is the most appropriate next step in management?

A 19-year-old woman is diagnosed with metastatic Ewing sarcoma. She has undergone multiple treatments without improvement. She decides to stop treatment and pursue only palliative care. She is of sound mind and has weighed the benefits and risks of this decision. The patient’s mother objects and insists that treatments be continued. What should be done?