"We Want Everything Done for Mama": Withholding and Withdrawing Treatment at the End of Life

Objectives:

1. Describe the benefits and burdens of anti-infective therapy, and artificial hydration/nutrition in patients with life-limiting illness. To be successful, the participant will be able to identify ethical issues and principles (autonomy, beneficence, nonmaleficence and justice) as well as therapeutic issues.
2. Given an actual or simulated patient/family dealing with an advanced illness, describe the roles of interprofessional health care providers in therapeutic decision making.
3. Given an actual or simulated patient/family dealing with an advanced illness, describe effective communication techniques concerning therapeutic decision-making among health care providers, patients/families and caregivers.

Activity Description:

Patients and families dealing with an advanced illness often make therapeutic decisions in isolation or based on an emotional response to the situation. This is especially true in cases of advanced illness where the benefits and burdens of interventions must be carefully considered prospectively. Occasionally “routine” therapeutic interventions (e.g., anti-infective therapy or hydration/nutrition) may actually increase the likelihood of patient harm in this vulnerable patient population. The purpose of this educational session is to help students identify the ethical principles and issues of withholding or withdrawing therapeutic interventions at the end of life and how to harness the utility of the interprofessional team, using effective communication through the entire process.

Students will work in interdisciplinary teams (modeling an interprofessional team) not to exceed 20 members, led by a minimum of two faculty members from different disciplines. Each group will participate in a facilitated discussion of one of the two cases (see below), with a focus on the role of each discipline and how the team approach optimizes therapeutic outcomes. After working in groups, entire class will reassemble for case closure and discussion.