WHAT WOULD YOU DO? ETHICS IN EMERGENCY MEDICINE Bernard Heilicser, DO, MS, FACEP, FACOEP-D

Bernard Heilicser, DO, MS, FACEP, FACOEP-D

What Would You Do?

Ethics in Emergency Medicine

The following dilemma was previously presented to us by an emergency department physician.

An 81-year old female was transported to the emergency department by EMS after an attempted strangling. It appeared her husband attempted to euthanize her by strangulation with a belt. The family discovered the situation and called EMS.

In the ED, the patient indicated that she had terminal breast cancer and was prepared to die. She refused all labs, IVs or treatment. The ED physician was unsure what his obligations were and what to do. If clinically stable, should the patient be discharged? Is there a need for psychiatric intervention or consultation?

WHAT WOULD YOU DO?

This would be rather perplexing. Does the patient have the inherent right to allow for her death, or should a psychiatric evaluation be entertained? If the patient demonstrates clinical psychosis would we not be demonstrating a fair objective evaluation of her clinical status? It would appear after a psychiatric evaluation if she has decision making capacity then discharge could be considered.

There is a thin line between decision making capacity and clinical psychosis, and this case certainly challenges this. The patient was referred for a psych consult and was ultimately admitted to inpatient hospice.

If you have cases that you would like to present or have reviewed in a future issue of The Pulse, email them to us at drolfe@acoep.org.

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