We post an ethical or situational concern that has arisen in a facility where one of our readers works. It has no identifiers included. It gives you only the facts of the case. Then, you can respond to that concern. This is an ongoing dialogue, with comments added as they come in. In the following issue, assuming it has been resolved, we give you the outcome from the facility where the incident took place. Please send any cases that you would like considered for inclusion to: info@plainviews.org

We hope that this new addition will help to inform not only those who are dealing with the issue, but will enable all of our readers to learn from the experiences and perhaps mistakes of others.

PLEASE NOTE: Due to unanticipated continuing responses to both the case and the resolution of the case, added responses can be viewed in the archives. Click HERE.

Case Conference #3 Resolution

The chaplain, who had been regularly visiting with the patient and helping the staff and doctors cope with the situation, called the two children. They had not visited their mother for several weeks. The chaplain asked them to come in to a meeting. They initially declined but the chaplain insisted and they acquiesced. The chaplain arranged for them to meet in the mother’s room in the ICU. Because it was a small community hospital and there was no patient advocate, the chaplain, who was also the co-chair of the bioethics committee, was asked to mediate this situation.

When the children arrived, the chaplain explained to them that since their mother had not left any advance directives, the hospital was, by law, continuing to do everything to keep their mother alive. The chaplain then asked them to look at their mother and to consider whether or not what was being done to maintain her “life” was what they wanted. They were shocked with the deterioration of her body and the level of medications that she was receiving to keep her heart going. She had already been coded and revived four times. From looking at their mother, it was clear to them that she was not going to “wake up” and change her will, nor could the court have her declared incompetent, since the judge would not be able to ask her any questions to determine her state of mind at the time that she changed the will. The chaplain was then able to get them to talk about what had caused the family rift in the first place and facilitated the beginning of saying goodbye to their mother. They then signed a DNR. The patient’s heart stopped the next day. No code was called.

Case Conference #3

A patient had won the lottery and her children had become more interested in her money than in a relationship with their mother. The patient had changed her will, excluding her children. Several months later, the patient suffered a massive stroke. She was connected to life support – intubated and receiving artificial nutrition and hydration. Her heart was starting to fail and the doctors approached the children about signing a Do Not Resuscitate Order because they felt it would not be in the patient's best interest to call a code and try to resuscitate her. The children refused to sign the DNR, hoping that they could get a court order and have their mother declared “incompetent” so that they could challenge the will. They also threatened to sue the hospital if the hospital staff did not do everything to keep the patient alive.

After several weeks and the physical deterioration of the patient’s body to a level that the staff considered to be “inhumane,” the staff asked the chaplain to talk with the children to see if the chaplain could convince the children to sign the DNR.

Should the chaplain intercede? If so, on what grounds?
If the chaplain intercedes, what should the “goal” of that intercession be?
Is this an appropriate use of the chaplain?

Please check below for comments made about the last CaseConference.

Send your comments about CaseConference to info@PlainViews.org.