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Mary is a 65-year-old G2P2 woman with lung
metastases from cervical cancer. She was recently
weaned from mechanical ventilation after being on
the ventilator for four weeks. She has a
tracheostomy. Mary currently has worsening
pulmonary function and needs to go back on the
ventilator or she will die within a few days. Mary's
husband, Jim, has power of attorney for Mary's
health care decisions. The attending offers Mary a
choice of either no ventilation with morphine for
comfort or resumption of mechanical ventilation.
Mary decides she prefers to go back on the
ventilator. Jim prefers that she does not go back on
the ventilator because the doctor has said that Mary
may never wean off of the ventilator again. Who
should make the decision about whether to put Mary
back on the ventilator?
A. Jim
B. All of them together
C. Mary's doctor in consultation with Jim
D. Mary
E. If Jim and Mary cannot agree, consult the ho -
ANSWER-D. Since Mary is still competent, she can
make her own decisions despite the fact that her
husband has power of attorney.
A 72-year-old G3P1 woman has progressive ovarian
cancer. She and her husband have already
completed a medical power of attorney form.
However, the patient did not complete a living will or
any other documents expressing her wishes for the
initiation of mechanical ventilation or cardioversion
in the event of a respiratory or cardiac arrest.
Unfortunately, the patient is brought into the
hospital after suffering an incapacitating seizure.
She is not arousable when she reaches the oncology
unit. Her husband Jim is present and willing to act as
Mary's surrogate decision-maker. When he decides
on the proper course of care, the husband should
make decisions based primarily on which of the
following?
A. What Mary would have chosen
B. Mary's best interest
C. Hospital Ethics Committee's recommendation
D. The family's wishes
E. His own wishes - ANSWER-A. A person who has
power of attorney should make decisions based on
what the patient would have wanted for herself,
regardless of what they think her best interests
might be
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