MedBugs: SAQ #370

Case: Advanced care directives in emergency care

A 75-year-old woman presents to the emergency department (ED) via ambulance following a witnessed collapse at home. She has a history of severe chronic obstructive pulmonary disease (COPD), congestive heart failure, and metastatic breast cancer. She is unresponsive upon arrival with no recordable blood pressure, a heart rate of 40 bpm, and oxygen saturations of 75% on high-flow oxygen. The paramedics report that her daughter, who lives with her, presented a copy of an advanced care directive (ACD) at the scene stating that she does not wish to be resuscitated, intubated, or have any life-prolonging interventions.

1. What is the current legal standing of advanced care directives in NSW? 3 marks

2. Outline criteria which need to be met for an advanced care directive to be deemed valid in NSW. 4 marks

3. If the advanced care directive is not deemed valid, provide the hierarchy of substitute decision-makers. 4 marks

You confirm that the ACD is valid and proceed to honour the patient’s wishes not to have life-prolonging interventions, starting them on an end-of-life pathway. The patient’s son who has Power of Attorney, arrives and requests his mother be resuscitated.

4. What is the role of a Power of Attorney? 1 mark

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Case: Advanced care directives in emergency care

1. What is the current legal standing of advanced care directives in NSW? 3 marks

2. Outline criteria which need to be met for an advanced care directive to be deemed valid in NSW. 4 marks

3. If the advanced care directive is not deemed valid, provide the hierarchy of substitute decision-makers. 4 marks

4. What is the role of a Power of Attorney? 1 mark

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