Ethical debate: The dilemma of the incapacitated patient who has previously refused consent for surgeryBMJ 1997; 315 doi: https://doi.org/10.1136/bmj.315.7121.1530 (Published 06 December 1997) Cite this as: BMJ 1997;315:1530
The case history
- J McFadzean, registrar in anaesthesiaa,
- J P Monson, reader in medicinea,
- J D Watson, senior lecturer in intensive care medicinea,
- J H Coakley, consultant in intensive care medicine (S.A.SIMS@mds.qmw.ac.uk)a
- a St Bartholomew's Hospital, London EC1A 7BE
- Correspondence to: Dr Coakley
A 72 year old Italian woman who spoke little English was admitted to hospital with a minor haemoptysis. Her medical history was complex. She had asthma, oesophageal varices, and recurrent small pulmonary embolisms, and had undergone partial thyroidectomy for a multinodular goitre. Her medication included salbutamol, ipratropium, becotide, warfarin, and thyroxine. Physical examination showed that the patient weighed 105 kg and had a large neck swelling that extended retrosternally. Her condition was otherwise stable.
A provisional diagnosis of minor pulmonary embolism was made, and the patient was given treatment to relieve symptoms overnight. The following morning she had an acute upper airway obstruction as a result of haemoptysis. She was resuscitated by the cardiac arrest team, intubated and ventilated, and was then transferred to the intensive care unit, where her …
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