Overriding Healthcare Proxy

[Sparda29]

I'm on my institutional APPE this month. I've been working in the CCU, following a few patients. One patient seems to be a problem. The patient's daughter refuses to allow us to give anti-seizure medications (originally on Fosphenytoin, which we converted to Phenytoin, then we converted that to generic Keppra.)

The patient's daughter has been informed of the high seizure risk and what can happen if the medications aren't given, but she responds by saying "So be it." Reasons for why she doesn't want the anti seizure meds are because they make the patient lethargic and give her hallucinations.

The patient is an 87 year old woman who came in to the ER with an acute stroke. Hallucinations aren't gonna result in her jumping off the roof. She's bed ridden with a NG tube. Not gonna go anywhere.

I mean, WTF? Can't the MD get a court order and override the daughter? This is something that Dr. House would be able to solve by morally guilting the daughter into giving the meds.

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[kvl1027]

I'm on my institutional APPE this month. I've been working in the CCU, following a few patients. One patient seems to be a problem. The patient's daughter refuses to allow us to give anti-seizure medications (originally on Fosphenytoin, which we converted to Phenytoin, then we converted that to generic Keppra.)

The patient's daughter has been informed of the high seizure risk and what can happen if the medications aren't given, but she responds by saying "So be it." Reasons for why she doesn't want the anti seizure meds are because they make the patient lethargic and give her hallucinations.

The patient is an 87 year old woman who came in to the ER with an acute stroke. Hallucinations aren't gonna result in her jumping off the roof. She's bed ridden with a NG tube. Not gonna go anywhere.

I mean, WTF? Can't the MD get a court order and override the daughter? This is something that Dr. House would be able to solve by morally guilting the daughter into giving the meds.

Does the patient have a documented seizure disorder or are you just prophylaxing and why? Typical post-stroke seizures are rare and seizure prophylaxis is not warranted. If the daughter is the medical proxy and then you have to assume the patient would prefer not to be "out of it". I'm sure Dr. House would be able to "guilt" her into allowing them, but this is not a TV show so..........

 

[Sparda29]

Does the patient have a documented seizure disorder or are you just prophylaxing and why? Typical post-stroke seizures are rare and seizure prophylaxis is not warranted. If the daughter is the medical proxy and then you have to assume the patient would prefer not to be "out of it". I'm sure Dr. House would be able to "guilt" her into allowing them, but this is not a TV show so..........

The patient has had 2 episodes of seizures so far while in the CCU.

 

[Hernandez]

personally if you wanted to show meds down me when I was on deaths door anyways that made my quality of life worse, I'd tell you the same thing. far too many people die in the hospital and not in their own beds....

 

[Carboxide]

If the patient was 27, I could see that. But there is nothing wrong with someone not wanting a very elderly person to be kept alive and stable with multiple medications when they are already severely disabled (in the CCU) and will likely succumb to another illness within a short time.

 

[tlh908]

Everyone is forgetting about tax implications. Maybe she is loaded and wants to die before the estate tax kicks in again at the start of next year. Only in America can we encourage people to die before the end of the year or else we take your money!