I’m working on a health & medical discussion question and need the explanation and answer to help me learn.
Mr. Clayton Khang, a healthy, active married 63-year-old Hmong man with two adult daughters, undergoes percutaneous transluminal coronary angioplasty. Suddenly, the monitors blare – Mr. Khang’s heart has stopped during the procedure. As emergency staff run into the room, the doctor repeatedly shocks the patient’s heart and pounds on his chest. Mr. Khang is quickly wheeled into the operating room so that the torn coronary vessel can be repaired and the blood flow restored to his body.
Following heroic efforts to save his life, Mr. Khang is comatose with nonspecific responses to pain. His family is distraught. Over the next few days, the patient progresses into oliguric renal failure with a need for hemodialysis. His neurologic status remains unchanged and his prognosis for recovery is considered very poor. However, after discussing long-term treatment and code status, his family rejects the suggestion of a DNR and opts for continuing aggressive treatment in the ICU.
One week later, Mr. Khang remains comatose, his life sustained by mechanical ventilation and dialysis. A neurologist confirms the bleak prognosis for a return to a conscious state. The patient’s family, however, insists on maximal therapy. “Dad’s a fighter,” they say. “We can’t give up on him. Do everything.” So, Mr. Khang remains in a deep coma in the ICU. During this time, he develops sepsis, a GI bleed requiring transfusion, fluid overload, and seizures.
Frustrated with the circumstances, the care team places a request for an ethics consult. You are the are the on-call ethicist. What do you recommend?
Expert Solution Preview
As the on-call ethicist, I would recommend having a compassionate and open conversation with Mr. Khang’s family regarding his current state and prognosis. It is important to acknowledge their emotions, the love they have for their father, and their desire to continue aggressive treatment.
In this situation, it is crucial to provide the family with a comprehensive understanding of Mr. Khang’s medical condition and the potential consequences of continuing maximal therapy. This includes discussing the significant risks and burdens associated with his continued comatose state, such as the development of sepsis, GI bleeding, fluid overload, and seizures. It is important to emphasize the poor prognosis and the unlikelihood of him regaining consciousness.
Furthermore, it is essential to explore the values and wishes of the patient. This can be done by discussing any advance directives or previously expressed preferences. If there are no explicit instructions from Mr. Khang, the healthcare team should encourage the family to consider what his wishes would be in this situation based on his values, beliefs, and past conversations with them.
The ethicist can also provide insight into the ethical principles that guide medical decision-making, such as autonomy, beneficence, non-maleficence, and justice. It is important to explain that prolonging Mr. Khang’s life in his current state may not align with these principles, as it may cause unnecessary suffering and potentially compromise his dignity.
Ultimately, the goal is to support the family in making an informed and considered decision. It is important to provide emotional support, empathy, and guidance throughout this difficult process. If the family continues to insist on maximal therapy despite the bleak prognosis, the healthcare team should respect their autonomy and continue providing compassionate care within the bounds of medical ethics and standards of care.
