A 74-Year-Old Woman Is Brought to the Emergency Department by Ambulance

question 134

Multiple Choice

A 74-year-old woman is brought to the emergency department by ambulance.  She is accompanied by a friend, who found the patient confused and disoriented lying on the floor in her apartment.  The patient is widowed and lives with her adult daughter.  She was diagnosed with aplastic anemia a year ago.  Her condition has responded poorly to immunosuppressive therapy and has required multiple blood transfusions.  The patient is febrile, disoriented, and unable to respond to questions.  Complete blood count shows severe pancytopenia.  The patient has an advance directive, signed 9 months ago, in which she designated the friend as her health care proxy.  The friend tells the physician that the patient did not want to undergo any further blood transfusions.  The patient's daughter arrives and adamantly insists that the patient receive a blood transfusion, saying, "I discussed it with my mother a few weeks ago, and we decided that she should have everything done to prolong her life."  Which of the following is the most appropriate next step in patient care?

• A)Contact the ethics committee for guidance because transfusion is not an emergency
• B)Honor the daughter's wishes because she lives with the mother and knows her better
• C)Honor the daughter's wishes, since she is the legal next of kin
• D)Honor the friend's instructions as health care proxy and withhold the transfusion
• E)Start the transfusion because the physician has a duty to provide emergency care

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Definitions:

Sociologists

Professionals who study social behavior, societal changes, and the social institutions and processes that influence human behavior and societies.

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Wedding Ring

A band, often made of precious metal, worn as a sign of marriage commitment and fidelity.

Social Exchange

A social psychological and sociological perspective that explains social change and stability as a process of negotiated exchanges between parties.