The Right to Die

You are a paramedic working in Auckland, you are responded to a fiesty 74 year old female called Ethel. Ethel lives independently at home, her house is immaculate and she is well dressed. She maintains all of her own Activities of Daily Living (ADL's) including her own shopping and house cleaning. She is usually fit and well and has no comorbidities. Her only medication is occasional paracetamol for arthritis related pain.

She has called the ambulance today as she is feeling 'generally un well'.

She greets you as you walk in, she is sat in the chair and is fully alert. She appears pale, a comprehensive medical assessment of the patient indicates that she has sepsis (infection of the blood) secondary to a Urinary Tract Infection (UTI) which has the potential to respond well to relatively simple interventions - I.e. Intravenous (IV) fluids, IV antibiotics, rest and a short stay in hospital. However if left untreated, it is likely that the sepsis will progress and lead to her death.

Ethel states that she has a good relationship with her family, however she does not want to be a burden to them, and so when you strongly recommend treatment and transport through to hospital or her General Practitioner (GP), she thinks it is best to stay at home and not burden the family. She will not under any circumstances allow you to contact them.

You assess Ethels competency to ensure she is able to fully comprehend the severity of the situation, and understands the implications of her decisions. You explain all the potential consesquences, including the fact that her refusal of treatment and transport may result in her death. She understands all information given to her and can repeat this information back to you when asked; she has no suicidal ideation, but understands that the sepsis may kill her and she is comfortable with this - she fulfills the requirement of being 'fully competent' as per ambulance guidelines.

You have already spent a significant amount of time with Ethel, you receive a notification from the Ambulance Control Centre that a new job is waiting around the corner and they are asking if you can respond.

Do you choose to repsond to the new job and leave Ethel alone at home to potentially die? Or do you choose to stay with Ethel and try to persuade her to come with you to hospital?