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Ethics Question

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TheBoneDoctah

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If a patient comes into the E.R. from an automobile accident and is unconscious and needs life-saving care, that patient does not need to give informed consent because it is implied and is an exception to the rule. However, what if the spouse of the unconscious patient is present? Since the patient is unconscious, would the spouse be considered a surrogate decision maker? Could a spouse under this circumstance deny care?

Ex: Patient comes in and is is dying and needs care but is not able to consent. The patient's husband is in the E.R. and says he does not want life saving care. What does the doctor do at this point?
 

swollcat

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If a patient comes into the E.R. from an automobile accident and is unconscious and needs life-saving care, that patient does not need to give informed consent because it is implied and is an exception to the rule. However, what if the spouse of the unconscious patient is present? Since the patient is unconscious, would the spouse be considered a surrogate decision maker? Could a spouse under this circumstance deny care?

Ex: Patient comes in and is is dying and needs care but is not able to consent. The patient's husband is in the E.R. and says he does not want life saving care. What does the doctor do at this point?

Under what grounds is he denying care? If no explicit reason is provided such as religious morality, I believe the correct answer is you render care by utilizing the principle of beneficence, etc.
 

NITRAS

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Six months ago, I'd would have told you:
If a patient isn't able to make a medical decision, then the surrogate decision maker should be found. The surrogate decision maker can request limitation in the care, including DNR. But keep in mind, things are state specific.

Thanks to the Texas Legislature, things are a little more complicated. A recent law passed requires written consent for a DNR. Only a MPOA (this is a legal document), living will, or legal guardian can sign a DNR form unless the patient is irreversibly terminal. And if that is the case, then a non-MPOA/LG surrogate decision maker cannot rescind the DNR.

:(
 

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