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CaseConference #9 (See responses below)

A 27-week gestational age baby was emergently delivered and admitted to a Level 3 Nursery Intensive Care Unit in stable condition.

The unit chaplain, following the established protocol of the unit, met the parents and completed a spiritual assessment. On the third day of life, the baby exhibited changes in his condition. Tests revealed that an Intraventricular hemorrhage had occurred. However, as is typical in premature infants, the extent of the bleed was uncertain. The neonatologist updated the parents as to the changes, range of possible outcomes, and the plan to monitor the baby closely, including additional tests in two days to reassess the bleed.

The next morning the chaplain received an emergent page asking for her presence as "the parents have been informed that the baby is to be removed from life support."

Upon arrival to the mother's room, the chaplain found the parents in tears. They stated that mom's doctor had been in earlier in the morning and informed them that "something happened in the night" and that "they need to take the baby off life support." Additionally, the doctor had instructed the parents not to leave mom's room "because a neonatologist will be coming down to talk with you when it's not so busy in the NyICU." The distraught parents had been waiting for several hours. They asked if the chaplain would go to the unit and baptize the baby "in case he dies before we are allowed to go be with him."

What is the chaplain's role in this situation?

Should the chaplain check the facts in the NyICU before responding to the page to be with the parents?

Should the chaplain advocate that the parents be allowed to be with their baby no matter how busy the NyICU?

Responses to CaseConference #9

I would check with staff (MD/RNs) regarding change in condition before I enter the room and get a sense of parent information/presence in the area. In the level 3 nursery where I am chaplain we have a digital camera and staff ( often me) take pictures of important milestones in baby's story (NICU diary) including emergent baptisms but we try to have
parents present for such events. Parents are asked if they would like to be present for withdrawal and we take and develop pictures immediately of the event on a photo printer. Because this part of our NICQ collaborative focus; Family Matters work group, staff focus is really on whole family care. We use a wooden screen for privacy and a rooming out-room after withdrawal.

I think part of the role of chaplaincy is advocacy in an area where the staff may be very busy and we are an extra pair of hands and a voice when parents have often verbalized the desire to be close when things aren't going well.

Chaplain Michelle M Dragonuk, AC, BCC candidate (post interview), BSN, MACM,MDiv
Carle Foundation Hospital
Urbana, IL

I would think it important to go into NICU prior to approaching the parents. In fact, I would have assumed someone in the family was probably at the baby's side so would have gone there first. In the given situation, it would be vital for the chaplain to go to the NICU after speaking to the parents to gather information to take to the family and encourage the neonatologist or the nurse caring for their baby to go to their room or allow them to come in. They should never have been given that kind of information and then left to wait in the mother's room "for hours" without clear and accurate information about their baby's situation. In our NICU here, the parents are taken immediately to the infant's side after such information is given and the news is only given when there is time for a physician to sit with them and tell them everything they need to know. I think that the first ethical blunder here was someone telling the parents this news without being able to tell them everything and answer their questions.

Dan Dixson M.Div., CT
Coordinator of Pastoral Services
Community Medical Center
Missoula, MT

Please check the archives below for comments made about the last CaseConference.

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