An adolescent with incurable cancer had been hospitalized

Palliative Care Management

Situation: An adolescent with incurable cancer had been
hospitalized for three weeks, spending the past eight days in the intensive
care unit. His physical deterioration and suffering created anguish in his
father and in the health care team. The attending physician discussed, with the
father, the likelihood of the adolescent having a cardiac arrest. He described
the actions the team would take for a full resuscitation as well as the varying
levels of resuscitation approved by the treatment setting (which included a
do-not-resuscitate option) and asked the father to express his preferences
regarding resuscitation. The father initially chose the do-not-resuscitate
status for his son and completed all of the official paperwork to implement
that decision. During the next 12 hours, the father actively solicited from
nursing, allied health and medical staff their definitions of
do-not-resuscitate. He then contacted the attending physician to rescind his
decision, choosing instead to have a full resuscitation order in place. He
explained his decision change, “When I saw that the staff did not all
define resuscitation in the same way, I decided that I would not leave that in
their hands. I am my son’s father and I will be his father to the end.”
This new decision was enacted and over the next four days, the young patient
showed clear signs of dying. His father stayed with him in the intensive care
unit and witnessed the changes in his son’s physical appearance. He began
commenting on those changes and on his son’s obvious suffering. Within two
hours of his son’s death, the father told the nurse that he did not want his
son to be resuscitated. This information was immediately conveyed to the health
care team and a brief discussion with the physician, father, and nurse was
convened to affirm this decision.

Questions

1.Define/describe do-not-resuscitate status? What has
contributed to this definition? How would you work with the father in
describing and deciding on the various resuscitation options? How do you
imagine the description of what occurs at the varying levels of resuscitation
might effect the father’s decision? What communication skills could have been
employed to facilitate this discussion/decision-making?

2. What constituted suffering for the son? The father?

3.What members of the interdisciplinary health care team do
you think could participate in this case—i.e. members that you see as having a
contribution unique to this case?

4. As a member of the health care team, what would be the
source of any personal distress or anguish in this case?

5. As a health practitioner, think about what the father
meant when he rescinded the DNR stating, “I am my son’s father and I will
be his father to the end.” How might the introduction of palliative care
and/or hospice at an earlier point in the son’s illness have changed this story for the son, father, and health care
team?

Explanation & Answer

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