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CASE STUDY

Mr. G has remained stable and his family desires to continue with his medical treatment. The team would like to meet with the family to discuss his goals of care but feel it would be best to have an interdisciplinary team (IDT) meeting first to review his medical condition and options for care before discussing with the family. Communication with the family has been uncomfortable with some members of the team as they have dealt with a number of different health professionals. A lot of information has been shared, often conflicting information, leading to confusion within the family about the nature of his illness. The social worker agrees to arrange an interdisciplinary team meeting. The attendees for the meeting include the unit physician, nurse practitioner, social worker, speech language pathologist (SLP), physiotherapist and nursing staff looking after Mr. G.

The IDT meeting is facilitated by the social worker who will also act as recorder for the meeting. The meeting begins with a medical review and update by the physician and nurse practitioner who are overseeing the medical care. The SLP then provides information about the patients feeding tube and need to consider more permanent options for feeding. This raises discussion with the team about the ethics of continuing to feed Mr. G. Some of the team members feel that his quality of life should be considered and the feeding tube should be removed, however others feel that the more permanent feeding tube is what the family seem to want based on comments from the family. The nursing staff mention that some members of the family often ask questions about the possibility that Mr. G may eat again and how much can he understand if they are speaking with him. The physiotherapist states that Mr. G is only receiving passive range of motion exercises to prevent stiffening of his joints and that he occasionally has reflexive movements that family interpret as positive signs of recovery.

The social worker then shares with the team that in her conversations with the family they believe that God will decide when Mr. G is to be called to heaven and that he is still with them and very much alive. They have been told by friends and church members that there have been miracles in which people wake up from comas and they believe that prayer will make this happen. There are many in the IDT that feel the ethicist should be brought in to speak with the family regarding the continued use of futile medical treatment. There are several on the team who cannot understand why the family would continue with treatment when Mr. G has such a poor prognosis.