NewsLine - September 2012 - (Page 30)

Short Takes What Do You Do When…? Practical Guidance From the NHPCO Ethics Committee Twenty-seven of your peers and colleagues serve on the NHPCO Ethics Committee and perform a key role in identifying ethical issues in hospice practice that need to be addressed at the national level. However, in addition to providing broad guidance, they can help hospices address the more delicate and, sometimes sticky, situations that arise in day-to-day practice. Below is one such situation that occurred at a hospice in southern Arizona, but likely occurs quite frequently in hospices around the country. A recounting of the situation and relevant facts is followed by the Committee’s recommendations on how best to handle it. The Situation Mr. B is a 65-year-old widower who is suffering from end-stage cardiac disease. He has been a patient of XYZ Hospice in southern Arizona for the past nine months, receiving the care from his residence at an assisted living facility. His condition suddenly worsened last night and the facility staff rushed him to the hospital in respiratory distress (EF of <15%). He is exhibiting severe congestion, low blood pressure, non-responsiveness and mottling in his lower extremities. He appears to be actively dying. Rather than intubate Mr. B., the intensivist would prefer to make him comfortable and return him to his home at the assisted living facility. His two adult children, on the other hand, want “everything” done to save him. If the parties involved cannot arrive at consensus within the next hour, Mr. B will need intubation followed by a “full court press.” The Patient’s Preferences Mr. B does not have the capacity to make medical decisions at this time. When he was admitted to XYZ Hospice nine months ago, he was alert and oriented, and chose to sign a DNAR; however, he did not complete a living will or a health care power of attorney form. Some Background Mr.B’s wife of 41 years died in a tragic accident two years ago and both of his children are still having a difficult time coping with her death. According to Mr. B’s daughter, Maureen, who is a social worker, Mr. B’s health seemed to decline rapidly after the loss of his wife. Maureen lives nearby and visits her father on a weekly basis. Being a LCSW herself, she has become friendly with Anne, the social worker at the hospice. Mr. B’s son, Kevin, lives on the East coast, but is very involved in his father’s life and speaks with Maureen frequently to keep abreast of changes. Kevin also travels to Arizona at least four times a year to visit his father. Mr. B loves the visits with both children—and cherishes time with his three grandchildren. Recommendations There is no doubt to the clinicians involved in this case that Mr. B is actively dying. The only people who feel more treatment is required are his two children. The Ethics Committee recommends that the hospice social worker hold a family meeting with his two children and 30 NewsLine

Table of Contents for the Digital Edition of NewsLine - September 2012

A Provider’s Guide to Live Discharges
A Message From Don
Handling Discharge for Cause
University of PA Health System’s CLAIM Program
Are You Offering a Non-hospice Service?
The Voice of NCHPP
Hospice Medical Director Certification
My.NHPCO: A Great Resource for Hospice Physicians
What Do You Do When…?
Honoring Veterans
Simione: Solving Your Hospice Challenges (display ad)
Member News and Notes
Compliance Tip of the Month
CTC 2012 (display ad)
Resource Links to Bookmark
Videos Worth Watching

NewsLine - September 2012