59 - Emergency and trauma medicine ethics

Summary

A 25-year-old male is brought to the emergency department by medics at midnight on Saturday night after being assaulted outside a downtown bar. The medics report that he was hit on the head and unconscious for a few minutes. When they arrived at the scene, the patient was confused but talking. He has a 4-inch laceration in his left parietal scalp and alcohol on his breath. When the patient arrives in the emergency department, he is slurring his speech and reports drinking several beers at the bar before being assaulted. He refuses any diagnostic tests or therapeutic interventions. He does not let the nurse start an intravenous line or draw blood, nor let the physician examine his laceration or do an adequate neurological examination. He demands to leave. He says he has been assaulted before and will be OK. He becomes increasing abusive to the staff and repeats his demands to leave.

The paramedics are called to a skilled nursing facility for an 80-year-old woman who is in cardiac arrest. The patient was last seen four hours previously by a healthcare aide and later found in her room unresponsive. When the medics arrive, the patient is unresponsive with no pulse or blood pressure. They call their base station asking to declare the patient dead. They say that it is futile to resuscitate elderly patients in nursing homs because such patients never survive. In addition, since she has been down a long time she will have severe neurological dysfunction. The patient has no advance directive.[…]