Articles  |   August 2014
ULYSSES DIRECTIVES: Should They Take Precedence Over a Laboring Patient’s Request for Labor Analgesia?
Article Information
Obstetric Anesthesia / Pain Medicine / Articles
Articles   |   August 2014
ULYSSES DIRECTIVES: Should They Take Precedence Over a Laboring Patient’s Request for Labor Analgesia?
ASA Monitor 08 2014, Vol.78, 40-41.
ASA Monitor 08 2014, Vol.78, 40-41.
A 29-year old patient we will refer to as “Trudy” presents in active labor with her second child. She is 7 cm dilated. Her first child was born without a labor epidural. Trudy has informed her nurse that this time she would like labor analgesia. The physician anesthesiologist arrives, interviews the patient and suggests neuraxial analgesia for labor. “Matthew,” Trudy’s husband, protests, pointing out that Trudy has a birth plan that states she does not want an epidural and that any requests from her for an epidural while she is in labor should be ignored.
In the Greek myth, Ulysses wanted to hear the song of the sirens – which was beautiful, but would inevitably lure a sailor to steer his ship onto the rocks. So he directed his crew to tie him to the mast so that he could hear the song but be prevented from misdirecting the ship, while his crew was instructed to block their ears and thus keep the ship on course no matter what he later commanded them to do. In obstetrical anesthesia, a Ulysses Directive (UD) is an advance directive that the woman creates prior to labor, instructing the physician anesthesiologist to ignore any requests from her for a labor epidural once she presents in labor. But is such an advance directive valid?
First Page Preview
First page PDF preview
First page PDF preview ×
View Large
0 Comments
Submit a Comment
Submit A Comment

Contributors must reveal any conflict of interest. Comments are moderated.

Name
Affiliation & Institution
I have a potential conflict of interest
Comment Title
Comment


This feature is available to Subscribers Only
ASA Member Login or Create an Account ×