DESIGNING EXIT STRATEGIES IN THE MIDST OF CHAOS:

Posted on in General
End of life management can become very complex because of the deep emotions involved, the uncertainty of the outcome, and the conflicting ideas about how to best manage the patient

Case Study: The client was an 91 year old grandmother who had been in the ICU for 10 weeks. She had irreversible multi-system failure.  There was confusion about the use of heroic measures.Even though the daughter had no medical training,  she had done the research on Google.

She was very upset because the nursing staff were not supplying the appropriate care.

The family wanted to avoid World War III and called Rupert Case Management to intervene.

 Outcome:

RCM completed a CASE REVIEW and got to know the family. It was clear that there was a need for clarity in the decisions about grandmother’s end of life management.

Instead of resorting to the courts, RCM arranged for an ethical review of the case.

The ethical review provided an emotionally intimate venue for evaluating the values of the patient, the family, the doctors and the community.

Even if the patient had a living will, decisions can be made that counter his/her wishes.

 The face to face meeting for the ethical review, which did include the daughter , was very effective in clarifying whether heroic measures were or were not appropriate.

In this case, heroic measures were not appropriate. The patient was in irreversible multi-system failure. With this realization came the appropriate management of the patient and a sense of calm before the patient passed.

There was no need to go to the Supreme Court to resolve matters. World War III was averted. The ethicist proved to be the key to a peaceful resolution of deeply emotional and complex end of life decisions.