You are called by the local Emergency Room regarding a 56-year-old white female patient of yours who has scleroderma (systemic sclerosis) and end stage renal disease. Her family brought her to the ER because she states that she no longer wants dialysis and has missed both dialysis today and two days ago. This patient has an advanced directive kept on file at her dialysis center.
How should you approach this case?
a. Contact the patient's family to discuss her wishes and the advanced directive, and provide support and guidance in this difficult decision-making process.
b. Advocate for the patient's autonomy and right to make her own healthcare decisions, while also addressing any potential concerns or fears she may have about discontinuing dialysis.
c. Collaborate with the ER team to ensure the patient's comfort and symptom management if she chooses to discontinue dialysis, while also addressing any potential legal or ethical implications.
d. Consider involving a palliative care or hospice team to provide additional support and resources for the patient and her family during this challenging time.