title: To transfer or not to transfer, that is the question.
abstract: An elderly patient who underwent a complex emergency abdominal aneurysmectomy two weeks ago is in coma, ventilator dependent, and in severe multisystem organ failure with a deteriorating prognostic index score. The family has become increasingly hostile towards Dr S. Cold, the consultants, the ICU nurses, and the janitorial staff. An estranged wife has called once to defer decision-making to the children. Three children intermittently visit and are openly critical of the medical care. One child is an ICU nurse supervisor at a small local suburban hospital. Dr Cold spoke to the family yesterday about instituting DNR orders and discontinuing some supportive therapy that was not working. The family first required another consultation and then demanded that Dr Cold transfer the patient to the hospital where the daughter works. The hospital does not provide tertiary care. A physician there is willing to assume responsibility. How should Dr Cold respond? A. Do as they request. B. Refuse outright. C. Call the accepting physician and explain why the case is futile. D. Take the matter to the ethics committee to prevent transfer. E. Call the wife and children to schedule an exploratory family conference and insist they come to a decision.
authors.affiliation: The Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, Tex., USA. jwjones@bcm.tmc.edu
authors.forename: James W
authors.initials: JW
authors.lastname: Jones
authors.forename: Laurence B
authors.initials: LB
authors.lastname: McCullough
mesh_terms: D017544:Aortic Aneurysm, Abdominal / Q000601:surgery*; D001291:Attitude of Health Personnel; D003128:Coma / Q000209:etiology / Q000628:therapy; D003422:Critical Care / Q000941:ethics*; D003657:Decision Making / Q000941:ethics; D034462:Dissent and Disputes; D007722:Health Knowledge, Attitudes, Practice; D006791:Hostility; D006801:Humans; D018447:Medical Futility; D009102:Multiple Organ Failure / Q000209:etiology / Q000628:therapy; D028701:Patient Rights; D010360:Patient Transfer / Q000941:ethics*; D011368:Professional-Family Relations; D012121:Respiration, Artificial / Q000941:ethics; D016414:Resuscitation Orders / Q000941:ethics; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000941:ethics*; D028761:Withholding Treatment / Q000941:ethics