Question:
A 49 year old with endstage motor neuron disease takes a deliberate, lethal, benzodiazepine overdose. As he becomes sleepy, he tells his wife what he has done and asks that he stays with him as he dies. They had discussed his wish to commit suicide before, rather than suffer the indignity and distress of respiratory failure in hospital. He has an advanced directive not to be ventilated in the event of respiratory failure. His power of attorney is a barrister who is also a close friend of both the patient and his wife.
She panics however, as he becomes unconscious and calls an ambulance. Finding him unconscious and in drug induced respiratory failure, the ambulance intubates and ventilates him and delivers him to the hospital emergency department.
You are the intensive care specialist on call and are asked to take him to ICU for ongoing care.
Outline the principles of the management.
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answer
complex situation:
5 areas need to be considered:
-the patient's autonomy: which is not acessible since he is unconscious due to OD
-nature of motor neurone disease: irreversible
-advanced directive for mechanical ventilation: clarifiy this, but OD has not been described
-the nature of power of attorney: health or financial: discuss this with that person
-support to his wife: reassure
-deliberate overdose: effect which may be reversible, but the secondary effect of possible ischaemic brain due to hypoxaemia?
Bring to ICU while those being resolved.
