DrVirgo
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4) no one !
In case of EMERGENCY, go ahead and treat. You as a doctor have to act on behalf of the patient and think, if a competent person was conscious faced with this decision, what woud he want? -There is a name for this, but I forgot what it's called...
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| inkspot
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have a look at this post :
http://www.prep4usmle.com/forum/thread/5154/
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| DrVirgo
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This is according to Kap Ethics Rule 7
When surrogates make decisions for a patient they should use the following criteria in this order:
1. Subjective Standard -what did the patient say in the past
2. Substituted Judgement -who best represents the patient OR what would the patient say if he could.
3. Best interest standard. Burdens vs benefits... and What would MOST people want in this situation?
If you don't have 1, go to 2... does the wife best represent the husband? if you think so then she can give consent... If not, then think in the best interest of the patient, and treat if you see fit.
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| inkspot
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i think the correct answer to such questions is wife if she refuses you go ahead and perform the surgery and then get some court orders later. (Best interest standard )
but atleast you seek consent from wife.
Even besides USMLE if you look @ this senario in practical life, a consent is given to next in kin ( wife kids guiardians etc ) and most of the times there is no objection. But not offering any consent would be wrong - my opinion
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| DrVirgo
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inkspot wrote:
i think the correct answer to such questions is wife if she refuses you go ahead and perform the surgery and then get some court orders later. (Best interest standard )
but atleast you seek consent from wife.
Even besides USMLE if you look @ this senario in practical life, a consent is given to next in kin ( wife kids guiardians etc ) and most of the times there is no objection. But not offering any consent would be wrong - my opinion
I agree with you, and you are mostly right especially this is how it happens in real life... Howeve for the purpose of the exam, they make a big deal for consent NOT from the next of kin but who represents the patient's wishes the best. For example: If a person is on life support, and a decision is being made to end it.
Who would you ask to make the decision? -
A) His gay lover who he lived with mostly all his life and who knows everything about him his, dreams, goals, and wishes, and has been at his bedside since he was admitted-This guy says to end life support because the patient stated the he never wanted to be kept alive by artificial means, and always valued a good quality of life.
OR would you go with the decision of
B) the estranged parents who have not seen their son in 20 years and don't know a thing about what he has been doing with his life, but just learned about the situation and flew down to visit him. -The parents plead you to continue life support because they would like to make up with their son once he comes out of it, and because he is young and deserves a chance to live the rest of his life.
-In this case you have to go with A -the lover, because he represents the patient's wishes the best, although the parents are next of kin/family. Agree?
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| inkspot
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complicated actually.
what if the gay friend is lying. more over i think in emergency if there is no from "gay lover" who claims to know "his" wishes means nothing. its not the same thing as DNR.
i have seen similar scenarios in which jew husband is unconscious and requires blood and the wife states that he is Je..?? witness and he has stated not to be transfused or he would have not liked to be transfused - the answer to those questions have been " transfuse " in emergency ignoring wifes beliefs. HOWEVER if the patient is concious and he denies transfussion it should not be given even if it means life loss.
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| DrVirgo
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inkspot wrote:
complicated actually.
what if the gay friend is lying. more over i think in emergency if there is no from "gay lover" who claims to know "his" wishes means nothing. its not the same thing as DNR.
The real exam just tests if you know who to listen to: the next of kin vs. the person who represents the patients wishes the best. Ofcourse there is no way of knowing if he is lying but the test won't be that hard. Just know this point though... It's very important.
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| DrVirgo
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inkspot wrote:
i have seen similar scenarios in which jew husband is unconscious and requires blood and the wife states that he is Je..?? witness and he has stated not to be transfused or he would have not liked to be transfused - the answer to those questions have been " transfuse " in emergency ignoring wifes beliefs. HOWEVER if the patient is concious and he denies transfussion it should not be given even if it means life loss.
Yes, in Emergency situation, if the wife says he is a Jehovah's witness -religious belifs are NO blood, or whatever he needs in emergency to save his life, forget her... Transfuse, and do what you need to do. There is no time to asses what the actual situation is and precious time will be lost trying to figure out if she is telling the truth or not.
BUT... IF the wife produces a card which states that the husband is of whatever religion and doesn't want blood transfusion, then you MUST listen to the wife.
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| inkspot
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agree
but that also means that you would not listen to the gay friend who is projecting your patients thoughts with out any documentation ! and you would treat him
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| DrVirgo
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going back to your original question my answer is still TREAT -in this case it is an emergency and you should treat first, ask questions later.
in case of witholding life support, in the absence of a living will, power of attorney or DNR orders and you have two people -pick the one who best represents the patients wishes, not next of kin... Thats the point I was trying to make.
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