27 Oct A patient with untreatable metastatic (widely spread) cancer of liver has lost consciousness and now has cold, pulseless extremities and irregular, gasping respiration.

Application: A patient with untreatable metastatic (widely spread) cancer of liver has lost consciousness and now has cold, pulseless extremities and irregular, gasping respiration. The clinical team believe that the patient is actively dying within hours at most, whatever resuscitative measure are undertaken. This would be an example of:

 

 

 

A) Physiologic futility

 

B) Quantitative futility

 

C) Qualitative futility

 

D) “Imminent-demise futility”

 

 

 

2) Application: The pt previously indicated that she would not want her life prolonged if she was not able to interact with her loved ones. She is now in a permanent vegetative state, having suffered irreparable  damage to the areas of the brain responsible for consciousness and sensation. Continuation of mechanical ventilation for this clinically stable patient in a permanent vegetative state would exemplify: (Mark all that apply.)

 

 

 

A) “Imminent-demise futility”

 

B. Physiologic futility

 

C. Qualitative futility

 

D. “Clinical futility”

 

 

 

3) Application: Chemotherapy for an advanced leukemia might result in a temporary remission of a fatal leukemia; however, such treatment would require repeated use of physical restraints on an adult with profound mental disability who could not understand why others repeatedly caused him pain. The pt is currently stable and pt would survive transfer back to his residence for hospice care. In this case, chemotherapy would be an example of:

 

 

 

A. Qualitative futility

 

B.  “Clinical futility”

 

C. “Imminent-demise futility”

 

D. Physiologic futility

 

 

 

4) Application: CPR (cardiopulmonary resuscitation) will simply not be effective in a patient who has lost so much blood that the heart cannot fill. It is not possible to restart the heart, if blood volume cannot be maintained.

 

 

 

A. Qualitative futility

 

B.  “Clinical futility”

C. Quantitative futility

 

D. Physiologic futility

 

 

 

5) Definition: Interventions that, on the basis of reasonable medical judgment, support continued life of the patient and without which the patient would be expected to die.

 

 

 

A. Time trial/Therapeutic time trial

 

B.  Comfort-only care

 

C. Withholding

 

D. Life-sustaining treatment

 

 

 

6) Application: If the patient’s blood pressure dropped, the current dose of vasopressors would not be increased to compensate for that; or, if the patient developed a new opportunistic infection, that would not be treated.

 

 

 

A. Comfort-only care

 

B. Withholding

 

C. Non-escalation

D. Time trial/Therapeutic time trial

 

 

 

 

 

7) Definition: Doing without an intervention; includes both not starting and stopping

 

 

 

A. Forgoing

B. Time trial/Therapeutic time trial

 

C. Withholding

 

D. Withdrawing

 

 

 

8) Application: Removing a patient from a mechanical ventilator after this supportive measure has been started.

 

 

 

A. Time trial/Therapeutic time trial

B. Withdrawing

C. Withholding

 

D. Forgoing

 

 

 

9) Application: Not beginning dialysis on a patient with an acute clotting disorder.

 

 

 

A. Forgoing

B. Withholding

 

C. Withdrawing

D. Comfort-only care