American Thoracic Society Quick-Reference GUIDELINES Apps
Issue link: https://eguideline.guidelinecentral.com/i/592878
Requests for legally proscribed or legally discretionary treatment Requests for futile intervention Treatments that may accomplish an effect desired by the patient, but for which there are laws, applicable judicial precedent, or public policies that prohibit or permit limitation of their use Interventions that cannot accomplish the intended physiological goals • Clinicians should work to understand the reason for the request and clearly communicate the rule that governs the request. • Clinicians should involve individuals with expertise in interpreting existing regulations to ensure the rule is correctly interpreted and applied. • Clinicians should consider involving communication consultants to assist in clear and accurate communication and psychosocial support for the surrogate. • Challenges to these rules should be handled by the relevant body that governs the rule. • Clinicians should explain the reasons that the requested intervention is ineffective and explore the surrogates' reasons for the request. • If conflict persists, clinicians should consider a second opinion to help clarify the medical facts and enlist communication experts to help empathically communicate the clinical reasoning behind the refusal and provide psychosocial support. • A clinician refuses to circumvent the organ allocation policy to help a critically ill patient get faster access to an organ for transplantation (proscribed). • A clinician refuses to prescribe a lethal dose of barbiturates for a patient who seeks physician- assisted suicide in a location in which such actions are illegal (proscribed). • A clinician refuses to provide ongoing physiologic support for a patient correctly diagnosed as brain dead who is not an organ donor in a state where brain death is recognized as death (proscribed). • In a state that has a statute governing "medically ineffective treatment," a clinician enters a DNR order for a patient with multiorgan failure and progressive metastatic cancer for whom, to a reasonable degree of medical certainty, CPR would not prevent impending death (discretionary) • A clinician refuses to perform CPR on a patient with signs of irreversible death (rigor mortis, dependent lividity). • A clinician refuses to administer antifungals as treatment for an acute myocardial infarction.