Ethics in the ICU

While shadowing in the ICU over the summer I encountered an older-adult patient who had terminal lung cancer. He was heavily sedated, attached to many machines, and reliant on a ventilator to breathe for him. He was considered to be at the end of his life by all of the ICU physicians and nurses. His oncologist was out of the country so they could not come assist in his medical care at the time.

Lung cancer has a low survival rate with most patients passing away within five years of the initial diagnosis (Lim, 2016). Towards the end of the patients life, they are usually in considerable pain which can result in a poor quality of life (Lim, 2016). When this occurs, management of the symptoms is often one of the only courses of action until their time comes (Lim, 2016).

A conversation occurred between the physician, a social worker, his wife, and his sons. They discussed the removal of his ventilator to allow him to pass away. The family became strongly opposed to the removal of his ventilator. They had a strong faith and one of his immediate family members is a pastor in their church. They were absolutely convinced a miracle was to occur, and he needed to continue with the extreme medical intervention until the miracle occurred. Additionally, they felt betrayed by the physicians for bringing up the removal of the ventilator, and the physician lost the trust of the family. The hospital brought in an additional member of their church and a close family friend who was also a physician to talk with the family and try to help them comprehend he was not going to getting better.

Ultimately, the hospitals ethical board had to get involved, and the board determined they would only allow two more weeks for a miracle to occur until his insurance would no longer cover his care. I understand wanting a loved one to live longer, but I think the family violated the biomedical principles of non-maleficence for this patient. They extended his pain and suffering, which I believe is doing the patient harm. Being alive for an additional two weeks while in an extremely poor condition must also be extremely hard for the family to watch.

Do you agree or disagree with what was decided? What would you have done differently if you were on his medical team?

Lim, R. B. L. (2016). End-of-life care in patients with advanced lung cancer. Therapeutic Advances in Respiratory Disease, 10(5), 455–467. https://doi.org/10.1177/1753465816660925