title: Obligations and frustrations with high-risk patients: ethics of physicians' evaluations.
abstract: A surgeon, Dr A. Droit, has been following a 97-year-old male with a type IV thoracoabdominal aneurysm, which became symptomatic this morning and is leaking. The patient is frail but active with no important comorbidities. The anatomy demands an open procedure. The patient is a former renowned physician who has been a longtime family friend of Dr Droit-like a grandfather. He presented incoherent with sagging blood pressure. A complicating factor is that Dr D. Rag, the chief anesthesiologist, decided that neither he nor any of his staff would provide anesthesia. Dr Droit knows an anesthesiologist who handles high-risk patients at another hospital in the medical center. The patient has worsened over the last hour, is becoming more unstable, and is unable to respond but his wife wishes to consent for surgery. What should Dr Droit do?
authors.affiliation: The Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, Tex. Electronic address: jwjones@bcm.edu.
authors.forename: James W
authors.initials: JW
authors.lastname: Jones
authors.affiliation: The Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, Tex.
authors.forename: Laurence B
authors.initials: LB
authors.lastname: McCullough
mesh_terms: D000367:Age Factors; D000369:Aged, 80 and over; D000758:Anesthesia / Q000009:adverse effects / Q000941:ethics; D000761:Anesthesia Department, Hospital / Q000941:ethics; D017545:Aortic Aneurysm, Thoracic / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D001291:Attitude of Health Personnel; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility / Q000941:ethics; D006439:Hemodynamics; D006801:Humans; D007258:Informed Consent / Q000941:ethics; D008297:Male; D028681:Moral Obligations; D018579:Patient Selection / Q000941:ethics*; D010360:Patient Transfer / Q000941:ethics; D010819:Physician's Role; D016079:Refusal to Treat / Q000941:ethics; D018570:Risk Assessment; D012307:Risk Factors; D018454:Spouses; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000941:ethics*