Medical Staff House Staff Orientation Manual - Montefiore Medical ...

HOW:
• Capacitated patients may refuse any treatment, including life-sustaining treatment.
• Health care agents for incapacitated patients may customarily refuse life-sustaining treatment
for the incapacitated patient. (See the policy for requirements.)
• Most treatment decisions for incapacitated patients who do not have appointed health care
agents are made by the attending physician in conjunction with the patient’s family or other
surrogate. These include decisions not to initiate specific treatments that would not be
medically indicated based on the patient’s condition and prognosis.
• Family members may also request the foregoing of one or more life-sustaining interventions
that are already underway (in particular, ventilatory support, ventricular assist devices,
dialysis and/or artificial nutrition or hydration). This is done by providing information about
the patient’s prior declared treatment wishes, indicating that the now-incapacitated patient
would have chosen to forego life-sustaining treatment under the current circumstances. The
Office of the Medical Director must be called to review the information provided by the
family and the physician documentation of this process.
• When a patient has no available or willing surrogate, life-sustaining treatment may be
foregone if such interventions(s) would merely prolong the dying process or increase
suffering. A Bioethics, Critical Care and/or Palliative Medicine consult may be helpful in
determining an appropriate plan of care. The Medical Director’s Office must be contacted in
these circumstances to coordinate multi-disciplinary review.
• Parents and legal guardians of minor patients may decide to forego life-sustaining treatments.
Pediatric Ethics, Bioethics, the Chief of Service, Palliative Care and/or the Medical
Director’s Office should be involved. Such decisions are made in the best interest of the
child. Consideration is given to the wishes of the parent and the child. The child is included
in the discussions, as appropriate.
• DNI orders are written to forego intubation in any circumstance other than cardiopulmonary
arrest. (See the Do-not-intubate (DNI) Policy for guidance in entering DNI orders for
decisions to forego intubation or re-intubation for moderate to severe respiratory distress or
any situation other than cardiopulmonary arrest).
CONTACT:
Medical Director 718-920-7052; 6078
Bioethics (Moses) 718-920-6226
(Weiler) 718-904-2299
INFORMED CONSENT AND REFUSAL
Administrative Policy and Procedure JC10.1
Note: This summary contains key points of Montefiore's consent policy. For complete
understanding of all the relevant provisions. it is necessary to thoroughly read the full policy.
WHEN
Informed consent is required for all procedures or treatments that are invasive or have potentially
serious side effects or complications. When a patient is a conscious and mentally capable adult,
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