Camb Q Healthc Ethics. 2016 Apr;25(2):338. doi: 10.1017/S0963180115000663.
The medical team found the patient to lack medical decisionmaking capacity. However, the team felt that the patient was still able to respond appropriately to some situations. KS had displayed a consistent refusal of all medical treatments that made her uncomfortable or caused pain. During her sister's visits, the patient would be much more receptive to eating. A meeting was planned with the patient's sister in which the ethicist explained that the patient was not able to make her own decisions. The patient's sister agreed that she would honor the patient's wishes but would let the team make any decisions outside of what she knew about the patient's preferences. The patient's sister agreed and was willing to be at the patient's bedside as much as she could to encourage her eating. If the patient's condition worsened, it was discussed that the team honor the patient's wishes and not force a feeding tube on her. The patient's code status was also addressed, and KS's sister felt comfortable in communicating to the team that the patient would not want to be resuscitated if medical treatments would not be able to improve her current quality of life. A natural passing away would be most amenable to the patient. The patient was discharged to her nursing home with a physician order for life-sustaining treatment (POLST) form signed by the sister documenting a do-not-resuscitate code status with comfort-focused treatments.
医疗团队发现该患者缺乏医疗决策能力。然而，团队认为患者仍能对某些情况做出适当反应。KS一直拒绝接受所有让她不舒服或引起疼痛的治疗。在她姐姐探视期间，患者会更愿意进食。计划与患者的姐姐召开一次会议，伦理学家在会上解释说患者无法自行做决定。患者的姐姐同意她会尊重患者的意愿，但会让团队在她所了解的患者偏好之外做出任何决定。患者的姐姐表示同意，并愿意尽可能多地守在患者床边鼓励她进食。如果患者的病情恶化，讨论结果是团队应尊重患者的意愿，不给她强行插入喂食管。还讨论了患者的急救状态，KS的姐姐放心地告知团队，如果医疗治疗无法改善患者目前的生活质量，患者不想被复苏。自然离世对患者来说是最能接受的。患者被送回养老院，其姐姐签署了一份医生开具的维持生命治疗（POLST）表格，记录了不进行复苏的急救状态以及以舒适为重点的治疗措施。
