{"pk":7795,"title":"When a Patient Declines Curative Care: Management of a Ruptured Aortic Aneurysm","subtitle":null,"abstract":"The management of major vascular emergencies in the emergency department (ED) involves rapid, aggressive resuscitation followed by emergent definitive surgery. However, for some patients this traditional approach may not be consistent with their goals and values. We explore the appropriate way to determine best treatment practices when patients elect to forego curative care in the ED, while reviewing such a case. We present the case of a 72-year-old patient who presented to the ED with a ruptured abdominal aortic aneurysm, but refused surgery. We discuss the transition of the patient from a curative to a comfort care approach with appropriate direct referral to hospice from the ED. Using principles of autonomy, decision-making capacity, informed consent, prognostication, and goals-of-care, ED clinicians are best able to align their approach with patients’ goals and values. [West J Emerg Med. 2013;14(5):555–558.]","language":"en","license":{"name":"Creative Commons Attribution-NonCommercial  4.0","short_name":"CC BY-NC 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNonCommercial — You may not use the material for commercial purposes.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by-nc/4.0"},"keywords":[{"word":"palliative care"},{"word":"end-of-life care"},{"word":"hospice care"},{"word":"clinical decision-making"},{"word":"autonomy"},{"word":"Emergency Medicine"},{"word":"emergency department"}],"section":"Ethical and Legal Issues","is_remote":true,"remote_url":"https://escholarship.org/uc/item/2sw7j693","frozenauthors":[{"first_name":"Sangeeta","middle_name":"","last_name":"Lamba","name_suffix":"","institution":"Rutgers, The State University of New Jersey, New Jersey Medical School, Newark, New Jersey","department":"None"},{"first_name":"Megan","middle_name":"","last_name":"Bonanni","name_suffix":"","institution":"Wayne State Medical Center, Detroit, Michigan","department":"None"},{"first_name":"Cheryl","middle_name":"A","last_name":"Courage","name_suffix":"","institution":"Wayne State Medical Center, Detroit, Michigan","department":"None"},{"first_name":"Roxanne","middle_name":"","last_name":"Nagurka","name_suffix":"","institution":"Rutgers, The State University of New Jersey, New Jersey Medical School, Newark, New Jersey","department":"None"},{"first_name":"Robert","middle_name":"J","last_name":"Zalenski","name_suffix":"","institution":"Wayne State Medical Center, Detroit, Michigan","department":"None"}],"date_submitted":"2013-04-08T21:52:12Z","date_accepted":"2013-04-08T21:52:12Z","date_published":"2013-09-15T07:00:00Z","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/7795/galley/4547/download/"}]}