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Teachable Moment
Less Is More
April 2015

What Are the Patient’s Wishes?

Author Affiliations
  • 1Harvard Medical School, Boston, Massachusetts
  • 2Division of Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
JAMA Intern Med. 2015;175(4):490-491. doi:10.1001/jamainternmed.2014.7991

An 83-year-old man with coronary artery disease and chronic renal insufficiency underwent a pylorus-preserving pancreaticoduodenectomy (Whipple procedure) for a pancreatic tumor. Although the patient was not considered an ideal surgical candidate given his comorbidities, he strongly favored undergoing the procedure, and his surgeon agreed to proceed after comprehensive preoperative evaluation. Prior to surgery, the patient told both his surgeon and his wife—also his health care proxy—that he wished to be “full code,” but if he could not be “brought back to [his] normal self,” he did not want to be “kept alive artificially” or have a feeding tube.