Background: Clinicians face substantial challenges in limiting life-prolonging interventions (e.g., ICU admission, life-sustaining treatments, invasive procedures) near the end of life, even when they judge these interventions to be non-beneficial [1-3]. The objective of our study was to empirically derive a descriptive framework of decision-making approaches used by clinicians to limit (i.e., withhold or withdraw) [...]

Background: Code status discussions often link do-not-intubate (DNI) orders with do-not-resuscitate (DNR) orders, although cardiac arrest accounts for less than 2% of endotracheal intubations. DNR orders are more commonly implemented for older patients with more comorbid conditions regardless of the reason for hospitalization, and are associated with withholding treatments outside of the cardiac arrest setting. [...]

Background: Moral distress, the inability to act in accordance with one’s ethical beliefs due to hierarchical or institutional constraints, has been associated with burnout and poorer well-being.  Significant moral distress amongst American physician trainees might occur when they feel obligated to provide treatments at the end of life that they believe to be futile or [...]

Background: Ethics is at the core of a physician’s professional identity. As internists, we are constantly grappling with medical and moral uncertainty. While ethical action is an integral component of professionalism, most residency programs offer little formal training to systematically explore the ethical dimensions of our work. Medical ethics education can promote moral development and [...]

Case Presentation: A 48-year-old woman, QF, with a past medical history of lupus nephritis and heart failure, was brought in for evaluation by her friend for fatigue and leg swelling. Despite documented medical problems, she denied having any health issues upon admission. Lab results revealed severe renal failure with a blood urea nitrogen of 163 [...]

Case Presentation: The patient is a 74 year old woman with past medical history of dementia and an aggressive right upper lobe cavitary mass who presented with post-obstructive pneumonia. The lung mass was diagnosed two years prior, however the patient refused further workup. The patient named her two daughters to be dual healthcare powers of [...]

Case Presentation: The patient is a 74 year old woman with past history of dementia and an aggressive right upper lobe cavitary mass who presented with post-obstructive pneumonia. The lung mass was diagnosed two years prior, however, the patient refused further workup. The patient named her two daughters to be dual healthcare powers of attorney [...]

Case Presentation: We present 2 amalgamated, anonymized patient cases, based on 5 ethics consults requested at a single tertiary care hospital over the past 4 years. In the first case, Ms. M, an 89 year old woman with a past history of severe COPD, debilitating chronic back pain, and recent imaging findings suggestive of a [...]

Case Presentation: 53-year-old woman with locally recurrent melanoma and a family history of Huntington’s Disease (HD) presented with complications of cerebral venous sinus thrombosis and subdural hematomas. On hospital day 2, she suffered a cardiac arrest in the setting of QTc prolongation from antiemetics leading to dependence on hemodialysis, mechanical ventilation, and pressors. She was [...]

Background: Non-beneficial treatment can be defined as medical interventions that are ineffective in achieving a patient’s desired goals or subject patients to discomfort without significant clinical benefit. At times, critically-ill patients are declined Intensive Care Unit (ICU) admission due to perceived lack of benefit but continue to be medically managed on the general medical floor. [...]