Question

Mr. Gonzalez is a 75-year-old man arrives at the emergency department febrile, short of breath, and confused. Many family members accompany the patient, including his wife, his siblings, his children, and his grandchildren. The physician wants to perform an emergency lumbar puncture, which the patient's wife and siblings are refusing. His 25-year-old granddaughter walks up with a health-care proxy form signed by the patient designating her as the proxy. She insists that you do the lumbar puncture stating that was her understanding of the patient's wishes. The rest of the family, including the wife, refuses the lumbar puncture stating that they know the patient's wishes better. What do you do?

A. Proceed with the lumbar puncture as per the granddaughter's request
B. Proceed with the lumbar puncture as per the wife and siblings' wishes
C. Seek a court order for a decision
D. Consult the hospital's ethics committee

Answer 1

In the case of Mr. Gonzalez, consulting the hospital's ethics committee is the most appropriate action due to the discord among family members about the lumbar puncture, despite the granddaughter presenting a valid health-care proxy. The lumbar puncture is performed in the lower lumbar area to avoid risk to the spinal cord, which ends between the first and second lumbar vertebrae.

Step-by-step explanation:

In the scenario presented, the decision-making process for Mr. Gonzalez's medical intervention becomes complex due to differing opinions within the family about whether to proceed with a lumbar puncture. If a valid health-care proxy is presented and the designee wants to proceed with the wishes of the patient as they understood them, typically, the healthcare team would follow the legally designated proxy's decision. However, because the rest of the family is in conflict and refusing the procedure, to ensure the legal and ethical consideration for the patient's best interest and alleviate the tension between family members, the most suitable approach may be to consult the hospital's ethics committee for guidance. The role of an ethics committee is to provide advice on complex cases where ethical, medical, and legal issues intersect.

The lumbar puncture, an important medical procedure performed to sample cerebrospinal fluid (CSF), is conducted in the lower lumbar region to avoid injury to the spinal cord, which typically ends at the first and second lumbar vertebrae. Therefore, performing the procedure below this level minimizes the risk of damaging the spinal cord.