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End-of-Life Choices: CPR & DNR WHEN PATIENT & FAMILY CONFLICT OVER DECISION: Ethical Considerations for the Competent Patient

End-of-Life Choices: CPR & DNR WHEN PATIENT & FAMILY CONFLICT OVER DECISION: Ethical Considerations for the Competent Patient

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Published by Dr. Liza Manalo
Guidelines for CPR or DNR discussions with patients, especially the terminally-ill. Dilemma faced in practice when patient's and families' wishes are in conflict.
Guidelines for CPR or DNR discussions with patients, especially the terminally-ill. Dilemma faced in practice when patient's and families' wishes are in conflict.

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Published by: Dr. Liza Manalo on Feb 04, 2013
Copyright:Attribution Non-commercial

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02/04/2013

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Liza Manalo, MD Withholding or Withdrawing Life Sustaining Treatment
End-of-Life Choices:CPR & DNR
 WHEN PATIENT & FAMILY CONFLICTOVER DECISION:
Ethical Considerations for the Competent Patient
LIZA C. MANALO, MD, MSc.
PALLIATIVE CARE
 
Liza Manalo, MD Withholding or Withdrawing Life Sustaining Treatment
SALIENT POINTS
40 year old female, married, nulligravid
Diagnosis: AdenoCA Left Ovary, Stage IV
S/P Explore lap, Left OophorecystectomyLeft Infracolic omentectomyBilateral Lymph node dissectionS/P Explore lap, Tube Jejunostomy, due to PGOdue to adhesionsType 2 DMAcute Kidney Injury, 2
0
to hypoperfusion
 
Liza Manalo, MD Withholding or Withdrawing Life Sustaining Treatment
SALIENT POINTS:
Medical treatment options, including chemotherapy, as well aspalliative and hospice care, and the prognosis of the diseasewere fully explained to the family.
The patient knew about the cancer diagnosis, but the actual
stage and prognosis were not disclosed to her, per family’s
request.
Patient is amenable to chemotherapy, pain management,artificial nutrition and hydration, blood transfusion, and IVmedications, but not to CPR, intubation, and mechanicalventilation. However, advance directives were not formallydiscussed and signed by the patient.
The patient’s natural family (parents and siblings) knew of thepatient’s wishes, but left the decision
-making to the husband.
When the patient went into respiratory distress due to
hospital acquired pneumonia, T/C sepsis, and had a CParrest, the husband agreed and signed the consent forCPR, intubation, mechnical ventilation and ICU admission.

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