Read this article and then utilize it to address the assignment.
Hospital ordered to keep 11-month-old in Texas on life support, appeals court says (nbcnews.com)
Scenario:
You were part of the Medical Decision Making (MSM) Committee at your hospital. You are also the Administrative Manager of the Respiratory Therapy and Treatment Department of the hospital. The MDM committee has been asked to decide the status of the patient is the link above.
NOTE: This case is an old case and is only being used as a foundation for this exercise
The physician members of the committee have recommended that the child be removed from life support, but the family is having difficulty accepting the decision.
As a member of the MDM committee and as a Health Care manager, whose responsibilities include the best care to the patients and to the fiduciary well-being of the Respiratory Therapy/Treatment Department. IT IS NOT your job to make the medical decision but to make decisions as they relate only to your department.
Consider the following:
- Describe in detail the information that you would like to have available to you to aid you in making your recommendation to the committee.
- As an Administrative Manager of the Respiratory Therapy/Treatment Department, discuss the issues related to your department that you would need to consider?
- Discuss, in detail, the justification for the recommendation would you make regarding the continuation of care for Tinsley? (Because this is a scenario, you have limited information gathered only from the article; in the real world you would know more)
- How would you describe the Moral Injury that might occur with those making the decisions and those caring for Tinsley?
Expert Solution Preview
Introduction:
As a member of the Medical Decision Making (MDM) Committee and the Administrative Manager of the Respiratory Therapy and Treatment Department, my role is to provide recommendations to the committee regarding the patient’s status and consider the department’s interests. In this scenario, the committee is tasked with determining the status of an 11-month-old patient in Texas who is currently on life support, despite the recommendation of the physician members to remove the patient from life support. The family is struggling to accept this decision. My responsibility is to assess the situation from the perspective of the Respiratory Therapy and Treatment Department, considering the best care for the patient and the fiduciary well-being of the department.
1. Describe in detail the information that you would like to have available to you to aid you in making your recommendation to the committee.
To make an informed recommendation, I would like to have access to the following information:
– Detailed medical records of the patient, including the nature of their condition, prognosis, and current treatment plan.
– Consultations from different medical specialties involved in the patient’s care, highlighting their perspectives on the potential outcome and quality of life.
– Input from the patient’s primary caregiver, if applicable, to gain insights into the daily care requirements, emotional well-being, and potential challenges.
– Opinions from ethicists or members of the hospital’s ethics committee regarding the ethical implications of discontinuing or continuing life support in this case.
– Information on the financial implications and potential strain on resources for the hospital, including the cost of long-term life support and any potential alternative treatment options.
– Any legal or policy considerations that may impact the decision-making process.
Having access to this comprehensive information will help me evaluate the factors that should be considered in making a recommendation to the MDM committee.
2. As an Administrative Manager of the Respiratory Therapy/Treatment Department, discuss the issues related to your department that you would need to consider?
As the Administrative Manager of the Respiratory Therapy and Treatment Department, there are several issues specific to my department that I would need to consider:
– Availability and expertise of respiratory therapists and other healthcare professionals required to provide and monitor life support for the patient. It is important to ensure that our department has the necessary staffing and resources to meet the patient’s needs if the decision is made to continue life support.
– Impact on departmental budget and resources, including the costs associated with prolonged life support for the patient, potential need for specialized equipment or medications, and any additional training requirements for staff members.
– Collaborative communication and coordination with other departments involved in the patient’s care, such as intensive care units and palliative care teams, to ensure a holistic approach to the patient’s treatment.
– Emotional and psychological support for the respiratory therapy team, considering the potentially long-term involvement in the care of a critically ill patient and the moral distress it may cause.
– Potential ethical concerns related to the allocation of departmental resources towards the continued care of the patient, especially if it poses a strain on the overall departmental functioning or impacts the care of other patients.
Considering these department-specific factors will help me make recommendations that align with the best interests of the patient while ensuring the optimal functioning and well-being of the Respiratory Therapy and Treatment Department.
3. Discuss, in detail, the justification for the recommendation you would make regarding the continuation of care for Tinsley?
Given the limited information from the scenario, my recommendation would only be based on what is provided in the article. In a real-world scenario, a more detailed assessment would be necessary. However, if I were to make a recommendation regarding the continuation of care for Tinsley based on the information available, I would consider the following justifications:
– The prognosis and quality of life: I would carefully evaluate the available medical information to assess the potential for recovery and the patient’s quality of life if life support were to be continued. If the prognosis is poor and the patient is not expected to have a meaningful and fulfilling life, discontinuing life support may be ethically justifiable.
– Consideration of the patient’s wishes: If there are documented preferences or advance directives indicating the patient’s own wishes regarding end-of-life decisions, those should be taken into account. However, in this scenario, such information is not mentioned.
– Balancing scarce resources: If the continued life support for Tinsley poses a significant strain on hospital resources, including the respiratory therapy department, and impacts the ability to provide care to other patients, it may be necessary to make a recommendation to discontinue life support.
– Ethical considerations: Consultation with ethicists and consideration of ethical principles such as autonomy, beneficence, non-maleficence, and justice would be crucial in reaching a recommendation. These factors would help assess the potential benefits and harms to the patient, as well as the equitable distribution of resources within the hospital.
Again, it is important to note that this recommendation is based solely on the limited information provided in the article.
4. How would you describe the Moral Injury that might occur with those making the decisions and those caring for Tinsley?
Moral injury refers to the psychological and emotional distress experienced by individuals when their actions or decisions conflict with their personal values, moral beliefs, or professional duties. In the case of making decisions regarding the continuation of care for Tinsley, moral injury can occur for both those making the decisions and those directly involved in the patient’s care.
For those making the decisions, such as the members of the MDM committee, they may experience moral injury due to the following reasons:
– Struggling with the conflict between providing the best care for the patient and respecting the family’s wishes or cultural beliefs, which can raise ethical dilemmas and feelings of guilt or moral distress.
– Bearing the responsibility of making life-and-death decisions and the potential consequences that may arise from those decisions.
– Feeling compromised in their professional integrity or values due to external pressures or constraints, such as resource limitations or legal considerations. This can lead to a sense of moral dissonance or emotional anguish.
For those caring for Tinsley, such as healthcare professionals in the Respiratory Therapy and Treatment Department, moral injury can result from:
– Providing ongoing care to a patient with a poor prognosis and limited chances of meaningful recovery, which may clash with personal and professional beliefs to do no harm or provide futile treatment.
– Witnessing the suffering and distress of the patient and their family, which can evoke feelings of helplessness, guilt, and emotional strain.
– Navigating the potential conflicts between the medical decision makers and the family, which may create ethical dilemmas, moral conflicts, and feelings of moral distress.
It is essential to provide support, debriefing, and resources for individuals experiencing moral injury in order to address their psychological well-being and maintain the quality of care provided to Tinsley.
