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.

CaseConference #9 Resolution

Upon receipt of the emergent page, the chaplain first checked with the NyICU staff, including the MD and RN, to be updated on the baby's condition and determine a plan of care to respond. The chaplain, after talking with the parents, called the NyICU to alert the RN and MD that she was bringing the parents to the unit.

A conference was immediately held with the parents to address the miscommunication and update them as to the baby's condition, continued plan of care and possible outcomes for the baby.

The parents expressed appreciation for the immediate response of the NyICU team; their immediate anxiety was reduced, and they spent time at their son's bedside.They requested that the chaplain baptize the baby in order to utilize their religious resources, which was provided with the MD and RN both participating in the ritual. The neonatologist addressed the issues of miscommunication and boundaries with the perinatolgist as well as the NyICU policies for communication with and presence of parents.

CaseConference #9

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?

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

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