New American College of Surgeons’ column: Surgeons need plan for managing patients with difficult EOL decisions
Determining the correct medical, ethical, and legal – and best – decision for a patient who is in a terminal state and unable to communicate their wishes is one of the most difficult clinical and moral challenges for the patient, the surgeon, and the patient’s family.
Making these difficult end of life decisions is the focus of a column in the October issue of the American College of Surgeons’ Bulletin, written by Lenworth M. Jacobs Jr., MD, MPH, FACS. The article covers The Joint Commission’s recently revised Rights and Responsibilities of the Individual requirements for accredited ambulatory surgical centers that further clarify who may exercise a patient’s rights on their behalf when the patient is unable to make decisions.
Modern medicine is now able to resuscitate and stabilize patients who in a previous era would not have survived the catastrophic event that caused them to require immediate hospital care. Examples of these kinds of events are major trauma with a prehospital cardiopulmonary arrest, a major cerebral hemorrhage, a prolonged cardiac arrest with cerebral anoxia, or a post-surgical event resulting in cerebral anoxia. All these scenarios can result in a patient who is being maintained on a ventilator with vasopressor support but who has no meaningful pathway to recovery.