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The Journal of the American Board of Family Practice 16:58-62 (2003)
© 2003 American Board of Family Practice

Medical Practice

End-of-Life Care for a Man with Developmental Disabilities

Ghan-Shyam Lohiya, MD, MS, Lilia Tan-Figueroa, MD and Francis M. Crinella, PhD

Fairview Developmental Center (GSL, LTF), Cost Mesa, Calif
Department of Pediatrics (GSL, FMC), University of California, Irvine

Correspondence: Address reprint requests to Ghan-Shyam Lohiya, MD, Fairview Developmental Center, 2501 Harbor Boulevard, Costa Mesa, CA 92626

Background: Science can artificially maintain many essential life functions. Does such care prolong life or dying?

Methods: A case is described of a patient with developmental disability with unknown health care choices who was hospitalized for drug-resistant urosepsis. He developed aspiration pneumonia, deep vein thrombosis, and respiratory arrest. He required gastrostomy, tracheostomy, artificial ventilation, parenteral nutrition, hemodialysis, multiple anti-infective agents, and blood transfusions. On day 58, a bioethics committee recommended against cardiopulmonary resuscitation. On day 66, the patient’s conservator concurred but required continuation of artificial ventilation. To the dismay of some caretakers, the patient continued to receive intrusive care until his death on day 104. The hospital charge was $709,206.

Results and Conclusion: Hospital care of patients with mental incapacity can be clinically and ethically challenging. End-of-life decisions can be facilitated when the patient’s legal representative and physician actively advocate the patient’s best interests and communicate frequently and openly. Suggestions are made for such exigencies.






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Copyright © 2003 by the American Board of Family Medicine.