October 26, 2009
There is a short but thoughtful piece in the new Hastings Center Report describing two clinical ethics consultants’ answering a pager on “Saturday Morning in the Clinic.”
The husband of a 7l-year old patient who had been in the surgical intensive care unit for eleven days following treatment for a small bowel obstruction faced a dilemma. His wife had told him—and all the members of the care team—that she’d “rather die than have a colostomy bag.” But she had become septic, requiring surgery on her previously resected intestine—likely resulting an an ostomy to save her life. What should he do?
The surgeon had told him that colostomies are sometimes reversible. So he had signed the consent form. But when the consult team spoke with the surgeon, the surgeon said that the patient, because of her condition, might have to wait a year before reversal could be considered.
And there was the rush and the young nurse’s reassuring the husband by saying, “It’s just a colostomy. She’ll die without it. Wouldn’t she rather live?”
And gradually the husband realized that no, she would not rather live.
But surgical preparations were being made at that moment and one member of the team stayed with the husband while the other fled to the operating theatre to say that consent had been revoked. The woman died two days later.
The consult team, reflecting afterwards on the harrowing Saturday morning event, realized that it was moral discernment that took over their lives during those hours: what they “needed to know” about the patient, her husband, her fears, his contradictory responses, that helped them through the process.
“[W]e found that our engagement in moral discernment was well served by our being continually alert to the changing conditions and circumstances of that Saturday morning in the clinic. . . .”
Preparation for case consults can never be pursued too aggressively in our ethics committee education. Do you agree?
Labels: medical ethics