Mrs.W was a 21 year old woman who was admitted to a local hospital with shortness of breath. During this admission, she was diagnosed with PCP( pneumocystis carinii pneumonia), right parietal infarct ( a blood clot in her brain) with left hemiplegia, and CMV( cytomegalovirus, an infection similar to mononucleosis). The patient was found to be HIV-positive during this admission. Her clinical condition deteriorated to the point where she was placed on intensive vasopressor therapy and antibiotics. She received maximum ventilatory support and was kept sedated all times. Despite the ventilator, she became hypoxic.

At this time, Mrs. W was 21 weeks pregnant with her second child. She had a four-year old son. Her husband completed a palliative care sheet three weeks after admission, requesting no CPR. The patient had no previous advance directive. Mrs. W's husband recently requested that if the child should be delivered, that it not be resuscitated.An ethnic consult was called by the ICU nurse in conjunction with the chief resident caring for this patient.

The patient was being cared for by the family-medicine teaching service of the hospital. Present during the consultation were the social worker, attending physician, the chief resident, and neonatologist, the patient's primary care mute, the nursing director of the unit, the hospital attorney and the pastoral care worker.

Under normal circumstances the family would be permitted to request the withdrawal or withholding of life-sustaining treatments when the patient no longer could speak for herself. However the patient's pregnancy seemed to place a different light on the case, especially for the hospital attorney.

The hospital attorney contended that according to the state's living will law, all effort must be made to provide for the birth of a viable infant. In other words, advance medical directive and the right to forgo life-sustaining treatment do not apply to pregnant women. He stated that the code status established a week ago was invalid and that the patient should be full code until the infant become viable outside the mother's womb.

The social worker and primary care nurse contended that the patient's husband and son should not have to bear the consequences of the life others may choose to maintain for them. The neonatologist believed that the infant would probably reach viability by 25 weeks of gestation, but this number could be wrong by several weeks in either direction. Because he believed it would violate the patient's dignity, the resident caring for this patient did not feel he could morally "push on the women's chest" despite the fact that she was pregnant.

1. Five sentences summary of the case
2. The quality of life of the patient
3. And contextual feature.

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1. Summary
A 21-year old woman was, on admission presenting with shortness of breath, found to be HIV-positive, with attendant infections and having suffered a recent stroke. Most importantly for the case, the patient was pregnant and the fetus was a number of weeks from viability; additionally, the...
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