Academic journal article The Hastings Center Report

Whether No Means No

Academic journal article The Hastings Center Report

Whether No Means No

Article excerpt

Dr. D is an emergency physician in a large urban hospital. One relatively quite evening Mr. R, a thirty-two-year-old male, presents to the emergency department complaining of shortness of breath. The problem, as it develops, is a depressingly familiar one to Dr. D. Mr. R, known to be HIV positive, turns out to be having his first episode of pneumocystis pneumonia, an often fatal disease of AIDS patients. The episode, fortunately, appears at present to be a relatively mild one; his blood test shows his lung function is only moderately impaired.

When Dr.D begins to explain this, Mr. R insists that his friend Mr. U be brought into the emergency department to listen to the doctor. Dr. D goes over the condition and describes the appropriate treatment: IV antibiotics. When asked, Mr. R denies any drug allergies.

As they grapple with the news that Mr. R has now changed from being a patient with HIV to one with AIDS, Mr. R and Mr. U produce a living will and durable health care proxy form designating Mr. U as responsible for decisionmaking if Mr.R becomes incompetent. The living will forbids cardiopulmonary resuscitation and prohibits "under any circumstances" endotracheal intubation and respirator ventilation, along with numerous other measures.

Dr. D believes strongly in patient autonomy. He therefore assures Mr. R and Mr. U that Mr.R's wishes, as clearly expressed, will be respected. After arranging for the papers to be copied and placed in the chart, he goes to admit Mr. …

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