Ethical issues and end-of-life care

This chapter presents a case of 84-year-old woman with a complaint of shortness of breath and fever. Emergency medicine presents a challenge in that emergency physicians (EPs) frequently have no preexisting relationship with the patient and are unfamiliar with patient's medical history and baseline level of health. Traditionally, the EP has focused on identification and management of acute and life-threatening illnesses with the primary goal of prolonging life. However, in ill geriatric patients who likely have multiple medical problems, this approach may not be ideal, and perhaps will be inconsistent with the patient's wishes. Patient-centered goals and patient-directed decision-making should be a key focus whenever caring for a geriatric patient in the emergency department (ED). However, given geriatric patients high burden of disease and potential cognitive impairment, especially near the end of life, EPs should, if possible, complete proper evaluation of a patient's decisional capacity.