A 17-Year-Old Boy Is Hospitalized with an Acute Exacerbation of Cystic

A 17-year-old boy is hospitalized with an acute exacerbation of cystic fibrosis.  His respiratory function had remained stable for many years but has begun to deteriorate, with 3 hospital admissions within the past 6 months.  The patient's FEV1/FVC ratio has decreased compared with a baseline reading taken 9 months ago and is 30% of predicted value.  He is placed on supplemental oxygen, antimicrobial therapy, and inhaled bronchodilators.  The hospitalist physician notices that there are no advance directives for this patient's care.  Which of the following is the best approach to take?

A) Contact the patient's primary care doctor and recommend that a discussion take place after discharge
B) Defer a discussion until the patient's condition has stabilized so that he does not lose motivation to participate in treatment
C) Involve the patient in a discussion about treatment options and advance care directives
D) Obtain legal consent from the patient's parents and implement their directives as soon as possible
E) Wait until the patient turns age 18 and is able to provide legal consent for his own directives

Correct Answer:

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