You are a pediatric critical care specialist working in the ICU taking care of a newborn infant who suffered a severe, prolonged reduction in blood flow to his brain at the time of birth. The consulting neurologist has indicated that the infant’s prognosis for functional neurological recovery is very poor in the unlikely event that he survives the next few days. You and the neurologist have spoken at length with the parents about the grim prognosis. They have decided that withdrawal of intensive care modalities and the initiation of optimal palliative care are consistent with their values. They have requested a day to hold their baby and to allow extended family to come and be with them prior to stopping the mechanical ventilation.
You have now gone home after handing the case over to a physician colleague who is on call for the unit that night, explaining that the family will notify staff when they are ready to withdraw life support.
You receive an agitated call from the ICU charge nurse at 2 am, as the family has requested life support to be discontinued but she is refusing to write an order for this, saying that she knows nothing about it. The parents are very distressed about this turn of events.
[Modified version of a case authored by Alixe Howlett]
- What are the boundary issues, if any, in this case?
- Are there issues with communication between team members?
- How should this be addressed?
- How should you deal with this situation when receiving the call at 2 am?
- Who should be involved in deciding next steps?
Some Values and Ethics Issues to Consider
- Compliance with policies and procedures
- Respect for professional integrity
- Patient-provider relationships
- Trust
- Respect for patient autonomy
- Respect for dignity
- Patient-family relationships
- End of life decision-making
- Patient-centered care
- Professional boundaries
