title: A Physician's Moral Dilemma in the Emergency Department: Going Against a Patient's Perceived Wishes.
abstract: OBJECTIVE
  We describe a case where a patient at the end of life with an advanced medical directive in place presents to the ED in distress.
  
  
  METHODS
  Our case is of a middle aged male with advanced cancer who presents in the ED with his family in respiratory distress requiring intubation. Even though his advanced medical directive states not for prolonged life sustaining support his wife and daughters plead with the physicians to save his life in order to end his suffering as well as prepare them for a more peaceful death.
  
  
  CONCLUSIONS
  We discuss the ethical and moral distress faced by ED physicians in such acute scenarios where a patient's perceived wishes are not in line with their families' pleas.
authors.affiliation: Yong Loo Lin School of Medicine, National University of Singapore, Singapore and Department of Anaesthesia and Intensive Care, Khoo Teck Puat Hospital, Singapore.
authors.forename: Shahla
authors.initials: S
authors.lastname: Siddiqui
mesh_terms: D016223:Advance Directives; D000368:Aged; D002277:Carcinoma / Q000150:complications*; D004635:Emergency Medicine / Q000941:ethics*; D004636:Emergency Service, Hospital; D004992:Ethics, Medical; D006801:Humans; D007442:Intubation, Intratracheal; D008297:Male; D000077274:Nasopharyngeal Carcinoma; D009303:Nasopharyngeal Neoplasms / Q000150:complications*; D011368:Professional-Family Relations; D012121:Respiration, Artificial; D012131:Respiratory Insufficiency / Q000209:etiology / Q000628:therapy*
keywords: advanced medical directive; end of life care; surrogate decision making