End of Life Decision-making:  Ethical and Legal Issues

Objectives:

1. Identify the role of hospital ethics committee members in addressing an ethical issue involving care for a dying patient.
2. Discuss the goals and interests of members of the healthcare team, hospital legal counsel, and ethics committee members when addressing values conflict at the end of life.
3. Troubleshoot strategies for mediating conflict when professionals disagree about what the “right” thing to do is in a case involving a dying patient in an acute care setting.
4. Evaluate the impact of one’s professional training on how ethical issues are handled in patient care.

Description: 

Mr. Jones is a 78 year old African American man who has advanced lung cancer that has spread to his liver and brain. He is admitted to the hospital intensive care unit (ICU) for treatment of pneumonia and septic infection. His wife of 55 years and four adult children believe that God works miracles through science. They insist that “everything be done” to keep Mr. Jones alive. The oncologist has determined that chemotherapy, biologics, and radiation therapy would no longer benefit Mr. Jones and would do more harm than good. The ICU physician suggests a referral to hospice care. The family refuses the referral and insists that Mr. Jones be kept in the ICU on maximal life support. The ICU physician requests an ethics consultation from the hospital’s ethics committee to determine if escalation of life-prolonging treatment in the ICU, including cardio-pulmonary resuscitation attempts, can be withheld as “medically ineffective” based on Maryland’s Health Care Decisions Act (HCDA).

Participants will act as members of the ethics committee to discuss the case. An ethics consultant will review provisions of the Maryland HCDA as relates to medically ineffective treatment. Two lawyers will offer their interpretations of what is allowed under the statute. Clinicians will address the psychosocial and physical aspects of end-of-life care for this patient and family. Attendees will discuss what recommendations they consider ethically justifiable in this case.