AMA Journal of Ethics®

Illuminating the art of medicine

Journal of Ethics Header

AMA Journal of Ethics®

Illuminating the art of medicine

Virtual Mentor. January 2005, Volume 7, Number 1.

Module 5

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Case 5.3: Withdrawing or Withholding Treatment—Respecting Patients' End-of-Life Decisions

Option Assessment

A.  

Because Mrs. Scott apparently has decision-making capacity, ordering the removal of the PEG tube is preferable and supported by the Code in Opinion 2.20, "Withholding or Withdrawing Life-Sustaining Medical Treatment": "The principle of patient autonomy requires that physicians respect the decisions to forego life-sustaining treatment of a patient who possesses decision-making capacity."

B.  

Asking Mr. Scott to persuade Mrs. Scott to keep the PEG tube should be avoided. It is not supported by, and may violate the Code in Opinion 2.20, "Withholding or Withdrawing Life-Sustaining Medical Treatment": "The principle of patient autonomy requires that physicians respect the decisions to forego life-sustaining treatment of a patient who possesses decision-making capacity."

C.  

Calling for a psychological evaluation of Mrs. Scott should be avoided because it is not a sensible alternative unless Mrs. Scott has given some indication that she may lack decision-making capacity. If she has not, then this is merely an attempt to circumvent her autonomy which violates the Code in Opinion 2.20, "Withholding or Withdrawing Life-Sustaining Medical Treatment": "The principle of patient autonomy requires that physicians respect the decisions to forego life-sustaining treatment of a patient who possesses decision-making capacity."

D.  

Informing Mrs. Scott that he will not remove the PEG tube should be avoided because it violates the Code in Opinion 2.20, "Withholding or Withdrawing Life-Sustaining Medical Treatment": "The principle of patient autonomy requires that physicians respect the decisions to forego life-sustaining treatment of a patient who possesses decision-making capacity."

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