Wednesday, January 13, 2010

Who is Practicing Medicine Here?

Rosemary Flanigan
January 13, 2010

A 72-year old African American woman is brought to the hospital by her 45 year old son. Upon admission she is diagnosed with renal failure, congestive heart failure, and a fever of unknown origin. She is unconscious. She is sent to the ICU and put on dialysis, a ventilator, and vasopressors. A few days later, while she is still unconscious, a PEG tube is inserted.

After a week the patient is showing no signs of improvement and is still unconscious so her family is invited to an ethics consultation on her case. Her family consists of her 45 year old son who is single, her 40 year old daughter, and a ten year old grandson who is autistic.

The entire family lives together in a home owned by the patient. The son says he is employed part-time but does not say where. The daughter is employed full-time but does not have health insurance so the cost of caring for her son takes everything she earns. The main income for the family is the patient’s social security and small pension.

All the caregivers are in agreement that further aggressive care is futile, but the family will not agree to withdraw care. They react angrily to all suggestions that their mother is dying. The consult ends in an impasse.

Two weeks later a hospice nurse calls the family and asks if their mother can be moved to hospice care. The daughter says, “No! and don’t call me again!”

My problem with this case is answering the question, “Who is practicing medicine?” here. The family has duties and responsibilities as does the institution and its practitioners. From what we know, the patient is receiving custodial care, but such care can be provided elsewhere more inexpensively.

Why would practitioners ask the family if the patient can be moved? Why doesn’t the case manager find a facility that will provide the level of care and the family be informed of the move?
Call me MEAN AND HEARTLESS—or call me a good steward of resources. BUT CALL ME SOMETHING!!!



Blogger risaden said...

Hospice care and custodial care are not the same care, so there may have been some misunderstanding. It's unclear from the information given if she is now vent-dependent, in which case she will continue to need long-term acute care indefinitely. The real ethical question is what would she have wanted, and how can that best be achieved? The family needs to be gently brought to the understanding that they can't make decisions based on what is best for them, but what is best for the patient. That often takes time.

Wednesday, January 13, 2010  
Anonymous Anonymous said...

I wholeheartedly agree. I think it is unconscionable that this is not considered to be a form of abuse or neglect. I checked, in two separate instances, when I called the local elderly abuse hotline.
I pride myself in being compassionate and empathetic. This is one instance where I can not bring myself to see things from the family's point of view. They are allowing a human being to to suffer and or linger for purely monetary reasons. If a hospital did it, it would be malpractice.

Tuesday, January 19, 2010  

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