A myriad of ethical challenges are present in this case study. A middle-aged man was admitted to a level I trauma-center in a large tertiary teaching hospital with multiple complicated severe injuries from a single motor vehicle accident. His identity was never accurately established and his wishes for his care were never elucidated. The ethical dilemmas and lessons learned are highlighted and discussed. The purpose for analyzing this experience is to understand the dynamics of the care given and to assist clinicians in the future with management of ethical issues in the care of difficult and disruptive patients.
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