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LIVING WILLS IN THE EMERGENCY ROOM

A patient who presents in an emergency room is presumed to be there for all necessary medical care. Patients who are conscious and able to make their wishes known may refuse unwanted medical care. (See Chapter 13.) But a living will should not be taken to forbid resuscitation efforts in the emergency room. Without prior knowledge of the patient, the physician should not assume that the document belongs to that patient or that it reflects the patient's wishes in that situation. However, at the same time that the resuscitation is being attempted, someone should try to clarify the status of the living will. The CPR must be stopped at the point that it is reasonably certain that the living will is authentic. Once a terminally ill patient's wishes are known, there is no justification for rendering unwanted treatment.

Emergency room personnel should not circumvent living wills by demanding unreasonable proof that the living will is valid. It must be remembered that the burden is on medical personnel to disprove the will if it appears valid on its face. If the will is not over a few years old, is clearly written, is signed and witnessed (many states make notarization optional), and the identity of the patient is well known, the living will is facially valid. Yet even if the will is valid, it is not an absolute bar to the forbidden care. If there is a reasonable probability that CPR or other lifesaving care will be successful, then it should not be withheld if there is an indication that the patient would have wanted the care. For example, an elderly patient in currently good health may have signed a living will out of fear of a lingering cancer death. This patient might very well want to be given emergency treatment and CPR after an automobile accident.


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