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J Palliat Med. 2013 Oct;16(10):1313-6. doi: 10.1089/jpm.2012.0366. Epub 2013 May 1.

Discussing goals of care for a delirious advanced cancer patient in the hospice setting.

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  • 11 Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer Center , Houston, Texas.


In the United States, patient autonomy is generally considered the most important ethical principle; however, patients sometimes make decisions that are medically futile or in conflict with the principles of beneficence and nonmaleficence. Difficult issues are often compounded if the patient loses capacity and a surrogate must provide substituted judgments. Allowing autonomy free reign can sometimes be detrimental to patient care and contribute to family distress. Here, we describe the case of a terminally ill patient whose conflicting desires were to have "everything" done--including cardiopulmonary resuscitation--and to simultaneously avoid hospitalization and die peacefully at home.

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