Abstract

A 68-year-old gentleman is brought into a New York City ER at 2:30 P.M. by the squad in response to a 911 call from his neighbor, who found him unconscious in his bed. The cause of his condition is not known, but the man is unresponsive and requires immediate life support, including intubation, IV fluids, and pressors. Within minutes, his son arrives and attempts to deny permission for the LSMTx, claiming that his father is in end-stage ALS and has an advance directive stipulating that he should not be invaded with LSMTx at this last moment in his life. The copy of the directive he produces is nonspecific in this context, because it qualifies refusal of LSMTx for “ … irreversible conditions …” and no one is sure if this situation is reversible. The advance directive names a daughter as proxy, and she is on her way from Maine, a 10-hour drive