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.

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CaseConference #5: (See below for responses)

A patient, who had small cell lung cancer and was in the hospital for chemotherapy, coded and was in the Intensive Care Unit. The family, divided on the extent of care that their loved one should receive, got into a fight in the ICU waiting room. The Chaplain, who had been with the patient and family prior to the code, was present when the argument started. The Chaplain was aware that the family had disagreed from the beginning on how aggressive the care should be for the patient.

What is the Chaplain’s role in this situation?

Given the chaplain's presence with the family what (if any) might be an appropriate intervention with this family?

Responses to Case #5:

It is my habit when there are multiple family members to try and figure out who seems to be (for lack of a better word) the power person in the family, along with the trait of calmness and reason. I try to gravitate towards that person in conflicting situations to encourage them to guide the family in proper ways. I would also, when reasonable, reduce the amount of persons involved in the conversations that are to follow...looking first for the legal next of kin.

Alan Faulkner, BCC,
Medical Oncology Associates of Augusta

No doubt, there were clues of a fight in the making before it actually erupted. This family is experiencing strong tension on at least two fronts, the 'code' event and the overall issue of care for the loved one, and they are ready to move toward some sort of resolution. As Chaplain, one of my first priorities would be to establish the primary emotional function of this fight. It might be a mutually agreed upon means to blow off steam. It could be an attempt to establish or reorder the family's emotional heirachy. It could indicate that family members are at very different places in their individual responses and are trying to 'come together,' or it could be a sign that everyone is just exhausted and desperately in need of a hiatus from the medical drama. Whatever the inspiration, they need to name and claim it if they are to heal the rift and move forward. Once we have a comfortable grasp of the conflicts underlying cause or causes, I would invite them to collectively consider a response, and depending on their needs and my relationship with them offer my observations.

Keith Goheen
Chaplain
Beebe Medical Center
Lewes, DE

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