title: Patient requested removal of ventilatory support in high-level tetraplegia: guidelines for the health care provider.
abstract: Determining treatment and extent of care has been returned to the patient with the advent of the durable power of attorney and reinforcement of patients' rights. To a great extent, patient autonomy replaced the medical team's role of beneficence in the decision-making process. Professionals acknowledge the patient's right in the decisional process of his/her care, though there is skepticism of such decisions being made by the patient who has suffered high-level tetraplegia within the acute care arena. This article explores (a) basing decisions upon life experiences and knowledge, (b) differentiating between informed consent for withdrawing care and consent resulting from stress or depression, (c) assessing the patient's psychological balance, and (d) advocating for the patient when he/she chooses to end all treatment options. Guidelines provide assistance to the health professional and the patient through a potentially volatile ethical dilemma. These provide insight into potential problems for all involved and clearly define steps that individuals should take to assure that the decision is made with informed consent rather than emotions.
authors.affiliation: Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
authors.forename: D M
authors.initials: DM
authors.lastname: Lemke
mesh_terms: D003657:Decision Making; D017809:Fatal Outcome; D006801:Humans; D008297:Male; D008875:Middle Aged; D009732:Nursing Care; D028701:Patient Rights; D011782:Quadriplegia / Q000523:psychology*; D013119:Spinal Cord Injuries / Q000523:psychology* / Q000534:rehabilitation; D016312:Treatment Refusal