Icu Crisis Management Medical Ethics Case Study

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Dr. Goldstein looked with concern at the small man lying in the ICU bed. " e nursing home had brought him to the hospital because of lung congestion. Dr. Goldstein glanced back at his notes: Ed, age #$, a white male with diabetes, high blood pressure, and poor vision. Somewhat mentally retarded. Dr. Goldstein knew from past experience that Ed functioned at about a !%-year-old level and tended to think very literally. Oh yes, and a hearing problem, thought Dr. Goldstein, seeing Ed’s hearing aid gleam under the room light. “Ed,” Dr. Goldstein said loudly. “Ed, you have no control over your esophagus. When you swallow, food and water are going into your lungs, which is making you sick. You have developed pneumonia from the infection. We can treat the pneumonia, but we need to put you on a ventilator and a feeding tube. We’d sedate you so that it wasn’t uncomfortable.” Ed stared up at Dr. Goldstein, blinking several times. His right eye drifted off to look into the corner of the room, but his other eye was focused on Dr. Goldstein. “Do I get an operation?” Ed asked. “OK, but I don’t want tubes, and please don’t cut off my big toe.” Dr. Goldstein sighed. Ed was running a fever and his oxygen levels were low in his blood. It was hard to talk to Ed in the best of times, so Dr. Goldstein wasn’t completely sure that Ed had understood him now. He tried again, shouting more loudly. “Ed! You have pneumonia. We need to treat it. You are very sick. We need to put in a ventilator and a feeding tube. Once the pneumonia is cured, we may be able to remove the tubes.” Ed shook his head, eyes rolling. “Go away! No tubes! No tubes!” Dr. Goldstein looked at Ed’s fi le. Seven years ago, Ed had checked himself into the local nursing home. When he entered the nursing home, and again three years ago, a patient advocate had helped him fi ll out an Advance Directive which

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