Ethics Question

Q. A 16 yo M presents to the ER in anaphylaxis. He accidentally ate a candy bar with peanuts, despite a peanut allergy. He states this has happened multiple times before, and he would like to have steroids and diphenhydramine (Benadryl) only. His lips are swollen, and you would normally opt to give an intra-muscular dose of epinephrine for angioedema. While he admits this reaction is worse than normal, he does not want a shot. His aunt states “whatever junior here says.” What is the most appropriate response?

(a) Thoroughly explain to the pt the risks/benefits of epinephrine, and if he still refuses, document the conversation in your chart and allow him to leave against medical advice after giving the steroids/Benadryl.
(b) Contact the pt's PCP, and have him/her try to convince the patient of the necessity for emergent treatment.
(c) Give the intra-muscular dose of epinephrine anyway.
(d) Give steroids/Benadryl and observe the patient. If he decompensates further and becomes unresponsive, then you may give the intra-muscular dose of epinephrine

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