Malcolm ("Mac"), age 64,
is an architect who was found to have an incurable cancer of the esophagus 5
months ago. He came to the Emergency Department 35 days ago with shortness
of breath and it was found that his tumor was compressing the large airways
going into both lungs. He was emergently intubated, admitted to the ICU,
and given ventilatory support which has now continued for more than a
month. Vigorous treatment has failed to shrink the tumor, and the ICU
physician and oncologist are both convinced that his condition cannot be
improved. Efforts have been made to awaken him to discuss limitation of
treatment, but he remains too confused to understand or to engage in meaningful
conversation. Because of his unawareness and his very poor prognosis, his
professional caregivers have said they believe continued ICU care is futile.
His only son, Paul, and wife,
Lindsey, have been very attentive and willing to consent to any therapy that
has been suggested so far. When presented a few days ago with information
about his terminal condition and imminent death, however, they were unwilling
to consider or even discuss any limitation of treatment, insisting that he
remain in the ICU, on ventilator support, on a “full code” status. They
stated that their deep religious faith (Methodist) required them to do
everything possible to preserve life, and they were counting on God to perform
a miracle. They report that the patient was also a man of deep faith who
would likewise insist on this approach.
Mac’s ICU nurse
reports that he remains unresponsive and does not appear to be
uncomfortable. She further reports overhearing a conversation between Paul
and Lindsey about the need to get the patient’s signature on a document that
would finalize a real estate venture that he and his son have
developed. An attorney came to the ICU to obtain the patient’s signature a
few days ago, but Mac was unable to understand or to sign the document.
*http://cbhd.org/content/continuing-futile-icu-support-relatives-insistence
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