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| Article - Abstract. To view full article click on the article title. | |
eMJA: End-of-life issues: Case 2 End-of-life issues: Case 2 Paul A Glare and Bernadette Tobin MJA 2002; 176 (2): 80-82 Abstract When a dying patient lacks decision-making capacity, the general practitioner needs to collaborate with family members in making decisions about forgoing life-sustaining treatment. The key to working out the best course of action is for the doctor to have a very clear idea of which treatment options he or she considers acceptable or unacceptable. The choice of treatment depends on a thorough evaluation of all the clinical information and careful reflection, bearing in mind that medicine has its own proper limits. Life-sustaining treatment may legitimately be forgone if it is (a) therapeutically futile, (b) overly burdensome to the patient, (c) not reasonably available without disproportionate hardship to the patient's carers or others, or (d) refused by the patient. Jenny, aged 42, has rapidly advancing cervical cancer unresponsive to antitumour therapy. Her husband, Michael, has asked you, her general practitioner, to make a house call, as Jenny is very drowsy today. You believe sepsis has intervened, worsening her renal failure (which is caused by malignant ureteric obstruction). Jenny has told Michael in the past that she would not like to "linger". However, Jenny's parents have left you frantic messages asking that she be admitted to hospital — they feel that Michael isn't "coping" and Jenny's children have not had time to adjust to the fact that she is dying. This is a very difficult yet relatively common scenario in end-of-life care. Jenny has an eventually fatal illness and has now developed an acute complication that will soon result in her death unless something is done quickly. Her case is complicated by the fact that you are unable to easily involve her in the decision-making process and there is disagreement within her family about what to do next. Full Article: http://www.mja.com.au/public/issues/176_02_210102/gla10630_fm.html |
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