Behavioral Science & Ethics USMLE Step 1 Practice Question
A 67-year-old man with advanced dementia and multiple comorbidities presents to the emergency department with fever (38.9°C), tachycardia (HR 102), tachypnea (RR 28), and hypoxemia (SpO2 88% on room air). Chest X-ray demonstrates a left lower lobe infiltrate consistent with aspiration pneumonia; WBC is 13,200/μL. Three years ago, when the patient had mild cognitive impairment, he completed a formal advance directive explicitly stating he does not want intubation or mechanical ventilation under any circumstances. His son, who holds medical power of attorney, is present at the bedside. The son states, "My father would want everything done. Please intubate him—he's a fighter and wouldn't want to give up." The patient is unable to communicate his current wishes due to advanced dementia. Which of the following actions is most appropriate?
Answer choices
- AHonor the patient's previously documented advance directive and pursue comfort-focused care with antibiotics and supplemental oxygenCorrect answer
- BIntubate the patient immediately to stabilize his respiratory status while the family considers the advance directive
- CDefer all interventions until a bioethics committee can review the conflict between the son's request and the advance directive
- DRefuse all treatment including antibiotics because the advance directive indicates the patient wants no aggressive interventions
- EAttempt to communicate directly with the patient to ascertain his current wishes despite his severe cognitive impairment
- FPetition the court to invalidate the advance directive based on the son's medical power of attorney and request for aggressive care
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