Abstract

Patients who are terminally ill sometimes seek treatment in the emergency room for a range of symptoms including pain and shortness of breath. The hectic, triage nature of the ER is not conducive to conversations regarding advance directives or the emotional, psychosocial, and spiritual needs of the patients or their family members. Some patients are treated aggressively with mechanical ventilation to support breathing without ascertaining if this is consistent with their wishes. Once the patient is intubated and placed on the breathing machine, admission to the intensive care unit follows. Admitting end-of-life patients who seek care in the ER to the ICU because they have been placed on a ventilator can be burdensome, disproportionate, and often futile, compromising the autonomy, dignity, comfort, and spiritual needs of the patient.