Medical Ethicist Abbott, MD walks us through her perspectives on myriad ethical quandaries including:  How to approach discordance between a patient's written wishes and a family member who says do the opposite, the ethics of operating on demented patients who have an acute life threatening critical illness, a case of a young man with an unsurvivable brain bleed and whether or not to extubate him before the family enters the resus room, strategies to skillfully guide families through withdrawal of life support, and the real consequences of restrictive hospital visitation policies.

Guest Bio: Dr. Jean Abbott is a medical ethicist and faculty at the Center for Bioethics and Humanities and Core Faculty, Master of Science in Palliative Care, University of Colorado Health Sciences Center. She is also Professor Emerita University of Colorado School of Medicine, and 30 year veteran of the emergency department.  Not part of her CV but germane to this show...she was my attending when I was a resident in the 1990s and had a profound impact on who I became as a physician. Irreverent, quick witted, and a tireless patient advocate, she is one of the finest physicians I have ever known. 

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We discuss:

• Visitor policy– one of the enduring tragedies of the COVID-19 pandemic;
• A case of a 45 year old with an unsurvivable brain bleed – Do you remove the endotracheal tube before the family enters the room to say goodbye or do you await their permission to extubate?;
• The struggle that society has with brain death;
• Withdrawing and withholding care in the emergency department;
• One way to approach death disclosure;
• Accommodating requests to delay death so family members can arrive to say their goodbyes;
• The case of a minimally communicative, demented (but happy) patient with a subdural hemorrhage who was unable to provide consent to surgery and has no POLST;
• Reasons why we tend to over treat in the ED;
• The scenario where the patient’s POLST form (eg. comfort measures only) and the desires of the power of attorney (do everything) do not align;
• Priming families in the ED;
• The ethical thing to do when you can’t get informed consent from a patient;
• Navigating the “Daughter from California”;
• When does the medical Power of Attorney kick in?