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Issues surrounding end-of-life decision-making

Authors Tejwani V, Wu YF, Serrano S, Segura L, Bannon M, Qian Q

Received 13 May 2013

Accepted for publication 3 July 2013

Published 9 August 2013 Volume 2013:7 Pages 771—775

DOI https://doi.org/10.2147/PPA.S48135

Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 2

Vickram Tejwani,1,* YiFan Wu,1,* Sabrina Serrano,2 Luis Segura,2 Michael Bannon,3 Qi Qian1

1Department of Medicine, Division of Nephrology and Hypertension, 2Mayo Graduate School, 3Department of Trauma, Critical Care, and General Surgery, Mayo Clinic College of Medicine, Rochester, MN, USA

*These authors contributed equally to this work

Abstract: End-of-life decision-making is a complex process that can be extremely challenging. We describe a 42-year-old woman in an irreversible coma without an advance directive. The case serves to illustrate the complications that can occur in end-of-life decision-making and challenges in resolving difficult futility disputes. We review the role of advance directives in planning end-of-life care, the responsibility and historical performance of patient surrogates, the genesis of futility disputes, and approaches to resolving disputes.

Keywords: end-of-life care, advance directive, surrogate, futility dispute, conflict resolution

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