MEDizzy - An 80-year-old woman presents with severe acute abdominal

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Ethical and Social Issues

An 80-year-old woman presents with severe acute abdominal pain. She is found to have bowel ischemia, severe metabolic acidosis, and renal failure. She has Alzheimer's disease and lives in a nursing home. Surgical consultation is obtained, and the surgeon feels strongly that she would not survive the surgery. When you approach the patient's family at this time, what would be the best way to begin the discussion?

ExplanationAlthough the issues underlying each of these choices might be fruitfully discussed with the family, ethicists have affirmed the duty of physicians to lead and guide such discussions based on their knowledge and experience. Health care providers should not inflict unrealistic choices on grieving families; rather, they should reassure them and describe the efficacy of aggressive palliative care in relieving the suffering of dying patients. In this case, a direct approach involving empathy and reassurance would spare the family from having to make difficult decisions when there is no realistic chance of changing the outcome.