A 72 year old retired school teacher admitted for coronary bypass surgery suffered a massive stroke and became unresponsive to deep pain. Three weeks after admission to the intensive care unit, aspiration pneumonia necessitated placement of an endotracheal tube with mechanical ventilation. After seven weeks of machine support (ten weeks of intensive care) the patient developed a rigid abdomen which was found to be caused by infarction of most of the small bowel. During post-operative management for bowel resection, toxic doses of antibiotics and large doses of vasopressor drugs caused renal failure and anuria. A consulting nephrologist declined to initiate hemodialysis pointing out that there was no chance that the patient could be restored to cognitive existence.
KeywordsEthical Concern Advance Directive Aspiration Pneumonia Coronary Bypass Surgery Legal Representative
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