An apparent 19 year old male is brought to the emergency room by ambulance experiencing respiratory failure related to the patient's AIDS virus. The patient is accompanied by his girlfriend who states that the patient has a do not resuscitate (DNR) order. As the emergency room physician tries to contact the patient's primary care physician he finds that the patient is under the care of a pediatrician and becomes suspicious about the DNR order. The doctor then confronts the girlfriend about the age of the patient because he is unable to communicate due to his respiratory condition. The girlfriend gives in and admits that the actual age of the patient is 17. The doctor immediately intubates the patient in an effort to stabilize his respiratory condition. After the patient is stabilized he informs the doctor that he does not want to be intubated again or placed on a respirator. After the patient's mother arrives the physician explains the preceding happenings including the DNR order given by the patient. The mother reluctantly goes along with her son's wishes and signs the documentation implementing the DNR order.
The patient soon confronts the doctor and makes him promise to stick to the DNR order no matter what his condition, the physician agrees. Shortly afterwards the patient goes into respiratory arrest. All the parties involved in this situation are present when the respiratory arrest occurs. The physician stands by with all intentions of honoring the DNR but within thirty seconds of the arrest, the mother orders the physician to intubate. The physician looks over at the patient as he shakes his head indicating that he does not want to be resuscitated, the physician is also aware that the patient is within 2 weeks of being 18. .
The major dilemma in this situation is who gets to make the life or death decision. It is clear what the patient wants for his course of treatment, but the mother is equally clear in the treatment her son should receive.