QUESTION: How should we make decisions about resuscitation status for this confused woman with no designated surrogate?
STORY: Nellie is a 97-year-old woman who was living alone in her own home until she was admitted to the hospital four days ago with weakness, decreased mobility, and confusion. She was found to have pneumonia, sepsis, renal insufficiency, and dry gangrene of one toe. She has responded surprisingly well to treatment, but remains frail, somewhat confused, and is at risk of further complications. Dr. Roberts, who has not previously known the patient, has attempted to have conversations with Nellie about her wishes regarding resuscitation, intubation, and other end-of-life care, but she has given inconsistent responses. He believes that CPR with chest compressions is unlikely to work if Nellie’s heart should stop because of her very frail ribs—however, he is not absolutely certain.