Bioethics Blogs

Right Way and Wrong Way: Making an Immediate Ethical/Legal Medical Decision

This thread is about what is the ethical and legal “right way” and what is 
the “wrong way”  for doctors and nurses in an emergency room to respond when they are in the act of attempting to save a patient’s life and then after resuscitation, started earlier by the paramedics, and was in progress was told by the patient’s surrogate to stop at once and let the patient die, not allowing the opportunity to taper off the resuscitation and observe possible recovery.  Here is the scenario as written as the Case Study in the September-October 2015 issue ofthe “Hastings Center Report” for which I have received permission to reproduce here. 

Robert F. is an eighty-five-year-old who suffered a heart attack at home in a rural location some thirty minutes from any major hospital. By the time the paramedics arrived, he was unconscious and nonresponsive. After spontaneous return of circulation, they began their standard procedure of therapeutic hypothermia. Robert’s core temperature was lowered using ice packs, and cold intravenous fluids were initiated. Soon afterward, Robert started to shiver when his body temperature reached 35.6° Celsius. He was then given a bolus of vecuronium as a neuromuscular blockade, sedated, and intubated. He was also given a low-dose vasopressin for blood-pressure control. Shortly after Robert arrived in the emergency room, his daughter, his medical decision-maker, produced an advance directive documenting that her father has a do-not-resuscitate (DNR) order, and she demanded that the breathing tube and any other life-sustaining treatments be withdrawn immediately.

The medical staff is very reluctant to comply with this demand for immediate action.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.