Her Son Brings an 86-Year-Old Woman with Alzheimer's Disease to the Emergency

Her son brings an 86-year-old woman with Alzheimer's disease to the emergency department with a worsening cough and exhaustion; she is diagnosed with pneumonia. The doctor describes the diagnosis and treatment plan, which includes hospitalization for intravenous antibiotics. The patient responds: "I'd rather go. I feel more at ease at home." She requests that she be released with oral antibiotics. The doctor says that intravenous antibiotics are preferable and that the dangers of infection increasing include sepsis and death. The patient understands the dangers and states, "I will return to the hospital if I feel worse; I simply don't enjoy staying in the hospital." The patient is widowed and lives with her son, who insists that she stay in the hospital for treatment.  He reports that his mother has been increasingly forgetful and has gotten lost several times while walking in the neighborhood.  On mental status examination, the patient is alert and oriented.  Mini-Mental State Examination score is 24, indicating mild cognitive impairment.  Which of the following is the most appropriate next step in the managment of this patient?

A) Consult the hospital ethics committee to help mediate the discussion
B) Follow the son's wishes because he is acting in the patient's best interest
C) Follow the son's wishes because he is the next of kin surrogate decision maker
D) Obtain a second physician opinion to determine the patient's decision-making capacity
E) Respect the patient's wishes because she has capacity to make her own decisions

Correct Answer:

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