You are a fourth-year medical student with a patient who has been in a severe motor vehicle accident. The patient has a subdural hematoma that led to cerebral herniation before it could be drained. Over the last few days, the patient has lost all brainstem reflexes and is now brain dead. You have the closest relationship with the family of anyone on the team. The ventilator is to be removed soon and organ donation is considered. Who should ask for consent for organ donation in this case?

Correct Answer: D

Rationale: The rules concerning organ donation are quite specific that the medical team taking care of the patient must not be the ones asking for the donation of organs. This is a conflict of interest. It pits the family's perception of the physician as caregiver against the impression that the medical staff just wants the organs. There can also be significant amounts of irrational thinking associated with grief such as the family thinking you only want to turn off the ventilator so you can harvest the organs. The medical team must stay clearly in the role of the people trying to preserve the life of the patient. The other most practical reason for the organ-donor network to ask is that their chance of successfully obtaining consent is far, far in excess of physicians who ask. The organ-donor network doing the asking both preserves the ethical integrity of the medical team in the eyes of the family as well as markedly increasing the supply of viable organs available for donation.

Correct Answer: A

Rationale: A competent adult has the right to do what she wants with her own body. This is true even if the decision seems foolish or unwise. This is also true even if the patient is pregnant and the fetus is potentially viable. Until the baby is born, a fetus does not have the rights of a 'person.' An undelivered fetus is judged as a part of the woman's body; hence she has the entire right to choose what will go on. Psychiatry evaluation and a court order are inappropriate because she is fully competent as per the description in this case. The father does not have the right to decide what to do any more than he has a right to consent to an appendectomy for the mother. The mother's right to refuse a C-section is the same as a mother's right to choose abortion. The father has no say.

Correct Answer: B

Rationale: Systemic medications affect the entire body by entering the bloodstream, unlike local medications.

Correct Answer: D

Rationale: Sublingual administration involves dissolving medication under the tongue for rapid absorption.

Correct Answer: B

Rationale: These are anticonvulsants primarily used to manage seizures.