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This episode presents an "Ethics Roundtable" discussion, focusing on the complex case of a 68-year-old female veteran, LK, whose advanced directive conflicts with her family's wishes regarding life-sustaining treatment. The source explores this ethical dilemma from multiple professional viewpoints, including a trauma surgeon, ethicist, spiritual care provider, physician, lawyer, and social worker. Each perspective offers insights into the challenges of honoring patient autonomy when a designated surrogate is deemed unsuitable and family members disagree with the patient's explicit end-of-life instructions. The central theme revolves around the legal and moral obligations to uphold a patient's advanced directive, especially when a surrogate's cognitive impairment or emotional distress prevents them from making decisions aligned with the patient's stated wishes.

keywords: autonomy, advance directive, surrogate decision making, substituted judgement

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This academic article explores the complexities surrounding dihydropyrimidine dehydrogenase (DPD) deficiency screening in patients receiving 5-fluorouracil (5-FU) based chemotherapy. The authors present a case study of a fatal reaction to capecitabine, a prodrug of 5-FU, to illustrate the severe, potentially life-threatening toxicity that can occur in DPD-deficient individuals. The text analyzes various methods of DPD testing, highlighting their limitations in meeting the criteria for routine screening, and discusses the ethical considerations of offering such testing. Ultimately, the article advocates for patient counseling on the risks of 5-FU and the option of DPD testing, while emphasizing the need for healthcare providers to monitor for early signs of toxicity and consider alternative therapies or dose reductions when appropriate.

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