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Ethics Committee Case Study John,

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Ethics Committee Case Study John, a 32 year-old lawyer, had worried for several years about developing Huntington's chorea, a neurological disorder that appears in a person's 30s or 40s, bringing rapid uncontrollable twitching and contractions and progressive, irreversible dementia. It leads to death in about 10 years. John's mother died from this disease. Huntington's is autosomal dominant and afflicts 50% of an affected parent's offspring. John had indicated too many people that he would prefer to die rather than to live and die as his mother had. He was anxious, drank heavily, and had intermittent depression, for which he saw a psychiatrist.  Nevertheless, he was still a productive lawyer. John first noticed facial twitching three months ago and two neurologists independently confirmed a diagnosis of Huntington's. He explained his situation to his psychiatrist and requested help committing suicide. When the psychiatrist refused, John reassured him that he did not plan to attempt suicide any time soon. However, when he went home, John pinned a note to his shirt to explain his actions and to refuse any medical assistance that might be offered, then, ingested all of his antidepressant medication.  His wife, who did not yet know about his diagnosis, found him unconscious and rushed him to the emergency room without removing the note. 
What should the care team at the emergency room do?

 

-How does the chronic diagnosis affect the team’s response to the acute condition?

-Were they informed?

-Was the patient competent to make that decision?

-Is there a surrogate decision- maker available?

-How should the diminished quality of life that is anticipated in the future affect the current decision?

-How should the emergency staff weigh the various competing legal and regulatory duties?

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