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 #14 Resolution

Prior to meeting the daughter in the hallway, the chaplain had several conversations with the patient, her family and with the staff. The chaplain had been an advocate for the patient, knowing that the patient had the right to say no as long as she fully understood the implications of her decision. Following a team meeting, a psych consult was ordered to ensure that the patient was not “clinically depressed” and understood the consequences of her decision. The psychiatrist found her both competent and not depressed. However, he felt that she should still have the surgery and would be “grateful afterwards.”

The staff used this recommendation by the psychiatrist as their rationale for trying to continue to “convince” the patient that she was making a mistake. The daughter was following through on her mothers’ wishes when asking the chaplain to have the staff support her mother’s decision stop trying to change her mind.

The chaplain initiated a conversation with the patient’s doctor and together, at the next team meeting, informed the staff that the patient’s wishes were to be honored. The staff was to begin discharge planning based on her wish to go to a nursing home where she would be kept comfortable with pain meds. The chaplain then spent quite a bit of time with the staff individually, helping them to understand why the patient’s wishes were to be honored.

An ethics consult was not necessary because the patient’s doctor eventually agreed with the wishes of the patient. This was a matter of staff being educated about the right of a patient to say “no” and to have that right upheld.

CaseConference #14

A 94-year-old woman falls and breaks her hip. She is brought to the hospital and refuses surgery to repair her hip. Mrs. S has been an independent woman, who lives by herself, still drives and her ADL (Activities of Daily Living) level is very high. The staff, believing that she does not understand that she could return to her home and have a meaningful life after surgery and rehab, continually try to convince Mrs. S that she should have the surgery. Mrs. S keeps saying that she wants to go to a nursing home, be given adequate pain medication and allowed to die. Her 69-year-old daughter is furious at the staff for trying to "convince" her mother to have the surgery. She meets the chaplain in the hall and tells the chaplain what is going on. The chaplain, a member of the Ethics Committee, wonders if this should be referred to that Committee.

What is your role as chaplain in this situation?

How would you approach the patient?

How would you go about assessing this patient?

How would you deal with the staff?

What is your role with the daughter?

Should the chaplain suggest to the daughter that she ask for an Ethics Consult?

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

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