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The Case.

Ruchika Mishra

    Cambridge Quarterly of Healthcare Ethics : CQ : the International Journal of Healthcare Ethics Committees
    |June 28, 2016
    PubMed
    Summary
    This summary is machine-generated.

    This case study highlights a conflict between a patient's family and long-term care staff regarding aggressive medical interventions for an advanced AIDS patient with progressive multifocal leukoencephalopathy (PML). Staff question the ethics of full code status due to patient distress and ineffective resuscitation.

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    Area of Science:

    • Medical Ethics
    • Geriatric Care
    • Palliative Care

    Background:

    • A 40-year-old male with advanced Acquired Immunodeficiency Syndrome (AIDS) and progressive multifocal leukoencephalopathy (PML) resides in a long-term care facility.
    • Initially responsive, the patient now exhibits distress during procedures and hospitalizations, with severe contractures suggesting a poor quality of life.

    Observation:

    • The patient's family insists on full code status and aggressive measures, despite staff concerns about patient suffering and ineffective resuscitation.
    • Nursing staff, who have developed an attachment to the patient, question the family's decisions and advocate for the patient's welfare.
    • Frequent hospitalizations for infections and pneumonia underscore the patient's deteriorating condition and the potential futility of continued aggressive care.

    Findings:

    • The nursing staff express strong reservations about performing cardiopulmonary resuscitation (CPR), citing anticipated physical harm (fractured extremities) and lack of expected benefit.
    • Staff initiated an ethics consultation, seeking protection for the patient and questioning the appropriateness of the family's decisions regarding his care.

    Implications:

    • This case underscores the ethical complexities in long-term care when patient-centered goals of care diverge from family directives.
    • It highlights the critical role of ethics consultation services in navigating conflicts and advocating for vulnerable patients.
    • The situation raises questions about defining "best interests" and ensuring patient dignity at the end of life, particularly in cases of severe cognitive and physical impairment.