Your patient has terminal metastatic cancer. In his record, you find a Physician Order for Life-Sustaining Treatment (POLST) form that clearly documents his wishes for symptomatic treatment only: Allow a natural death; do not intubate; do not perform CPR. However, he isn’t enrolled in hospice because he’s still receiving oral chemotherapy. On exam in the emergency department, he’s in extremis, and so is his family. You’re worried he may be dying, but he isn’t going gently into that good night.
What’s your approach?
DEFINING THE EMERGENCY