Behavioral Science & Ethics USMLE Step 1 Practice Question
A 67-year-old woman with moderate-to-advanced Alzheimer disease is admitted to the hospital with aspiration pneumonia and acute hypoxic respiratory failure. She is currently intubated and sedated. Her son insists on continued aggressive interventions including vasopressors and potential renal replacement therapy. Her daughter states that 2 years ago, before cognitive decline, the patient told her "I don't want to be a burden on my family if I can't recognize them anymore." No advance directive, living will, or durable power of attorney for healthcare exists. The patient has no spouse. Which of the following is the most appropriate first step in resolving this conflict and guiding medical decision-making?
Answer choices
- AImmediately petition the court for emergency guardianship to establish legal decision-making authority
- BRequest that the hospital ethics committee review the case and facilitate family discussion using substituted judgmentCorrect answer
- CHonor the son's wishes for aggressive care since he is the eldest family member present
- DPlace a do-not-resuscitate order based solely on the patient's previously stated values mentioned by the daughter
- EContinue all life-sustaining measures until a legal guardian is formally appointed by the court
- FDischarge the patient from the hospital to allow the family to make decisions at home
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