Background: Science can artificially maintain many essential life functions. Does such care prolong life or dying? Methods: A case is described of a patient with developmental disability with unknown health care choices who was hospitalized for drug-resistant urosepsis. He developed aspiration pneumonia, deep vein thrombosis, and respiratory arrest. He required gastrostomy, tracheostomy, artificial ventilation, parenteral nutrition, hemodialysis, multiple anti-infective agents, and blood transfusions. On day 58, a bioethics committee recommended against cardiopulmonary resuscitation. On day 66, the patient's conservator concurred but required continuation of artificial ventilation. To the dismay of some caretakers, the patient continued to receive intrusive care until his death on day 104. The hospital charge was $709,206. Results and Conclusion: Hospital care of patients with mental incapacity can be clinically and ethically challenging. End-of-life decisions can be facilitated when the patient's legal representative and physician actively advocate the patient's best interests and communicate frequently and openly. Suggestions are made for such exigencies.
Other information suggests that immigrants might have relatively low screening levels. In a neighborhood site screening program, only 51 per cent of Haitians reported a previous Pap test, compared to 77 per cent of ESC women and 89 per cent of US-born Black women.6 Haiti, the poorest Caribbean country, has limited medical services through which Pap tests can be provided.7 English-speaking Caribbean countries vary in the extent and quality of their health services, but many women receive Pap tests during prenatal or contraceptive care.8 The frequency of screening among immigrants is a function of age, socioeconomic level, and country of origin. In the USA, cultural, financial, and linguistic barriers (compounded by documentation problems) lead to a relatively low use of preventive health services among low-income Caribbean immigrants.Haitians have a higher incidence of tuberculosis than other immigrants,9 but evaluations of the health status and the need for services among the varied groups within Black and immigrant communities are lacking. Such studies are essential if focused, cost-effective education and screening services are to be implemented.
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