Kendra Cooper

This case series presents three instances where care teams grappled with how to reconcile the two ethical principles of beneficence and patient autonomy when incapacitated patients actively resisted life-sustaining treatment. Readers are invited to consider how differences in patient demographics, psychiatric comorbidities, urgency and duration of recommended medical interventions, and clinical contexts impacted clinical decision-making and outcomes in each case. Physicians should consider the risks and benefits of proposed interventions, including the risks of the means necessary to force interventions in nonassenting patients, and include these factors in consent discussions with patients’ legal next of kin. Physicians should also reflect on how their own potential biases may impact what treatments they offer and when, and they should seek consultation with hospital ethics committees when members of the care team have differing views on how best to proceed with patient care. Momentary capacity assessments should not be universally applied in evolving clinical scenarios when risks versus benefits of proposed interventions rapidly shift, nor should lack of availability of next of kin prevent emergent lifesaving treatment or interventions that could restore a patient’s capacity and ability to have more nuanced discussions about the long-term care trajectory.