Ethics of emergency bedside medicine

It came out of the blue. A former client contacted me with news of her sick father, who was in his late 70s. He had been admitted to hospital with severe pneumococcal necrotising pneumonia and septic shock, acute kidney injury, and respiratory failure. Two months on he was still in the critical care unit on a ventilator.

The family members were unhappy with the medical team’s management plan, which was to continue aggressive treatment unless he suffered significant deterioration. In that case, there would be no escalation in support. The family wanted everything done unless the situation wasn’t survivable.

I went to the bedside to see the patient. He could not speak. I asked him how he was and he gave a thumbs up. I asked him if he …