End-of-life care for a man with developmental disabilities.
BACKGROUND
Science can artificially maintain many essential life functions. Does such care prolong life or dying?


METHODS
A case is described of a patient with developmental disability with unknown health care choices who was hospitalized for drug-resistant urosepsis. He developed aspiration pneumonia, deep vein thrombosis, and respiratory arrest. He required gastrostomy, tracheostomy, artificial ventilation, parenteral nutrition, hemodialysis, multiple anti-infective agents, and blood transfusions. On day 58, a bioethics committee recommended against cardiopulmonary resuscitation. On day 66, the patient's conservator concurred but required continuation of artificial ventilation. To the dismay of some caretakers, the patient continued to receive intrusive care until his death on day 104. The hospital charge was $709,206.


CONCLUSIONS
Hospital care of patients with mental incapacity can be clinically and ethically challenging. End-of-life decisions can be facilitated when the patient's legal representative and physician actively advocate the patient's best interests and communicate frequently and openly. Suggestions are made for such exigencies.
Lohiya
Ghan-Shyam
GS
Fairview Developmental Center, Costa Mesa, Calif 92626, USA.
Tan-Figueroa
Lilia
L
Crinella
Francis M
FM
D000328:Adult; D002140:California; D016887:Cardiopulmonary Resuscitation; D003657:Decision Making / Q000941:ethics; D028741:Ethics Committees, Clinical; D017722:Hospital Charges; D006801:Humans; D008607:Intellectual Disability; D007926:Lesch-Nyhan Syndrome / Q000191:economics / Q000628:therapy*; D008297:Male; D018447:Medical Futility; D019989:Persons with Intellectual Disabilities; D012121:Respiration, Artificial / Q000191:economics; D013727:Terminal Care / Q000191:economics / Q000941:ethics*