Maximal medical therapy and palliative care can work together: When are advanced care measures appropriate?

Abstract

Resuscitation status and patient wishes in terms of advanced cardiopulmonary support must be addressed during inpatient hospital admissions. However, the lack of clarity of the patients’ wishes and the variability in physicians’ comfort addressing these issues often leads to ambiguity in an emergency setting. This may result in inappropriately aggressive management, and conversely, it may also lead to withholding potentially lifesaving therapy due to ‘‘Do Not Resuscitate’’ (DNR) designation. We report a case of hemodynamic instability due to acute supraventricular tachycardia (SVT) in a patient with a DNR designation. He was successfully treated according to the advanced cardiac life support (ACLS) protocol for SVT. We also discuss some of the ethical challenges of providing potential life-sustaining interventions in palliative medicine, as well as the dilemma of whether or not to provide such interventions to patients who have DNR status.