The Angela Smith case has the potential of being a major professional and ethical dilemma because the will of the patient has come to be paramount in modern practice. The primary obligation of the caregiver is to carefully guide the patient, who in this case includes family members, into making the right decision (Lord, Livingston, & Cooper, 2015). The dilemma lies inter alia in the fact that whatever decision the family makes, whether right or wrong, it will stand. Secondly, the decision-making rationality of the family is exponentially diminished by their faith and spirituality, yet the family is entitled to the said faith and spirituality (Swinton et al., 2017). It is, however, almost impossible to ignore the fact that the family may be in this situation in part because of their faith. Ms. Smith’s hypertension had gone uncontrolled for some time, leading to the bursting of an aneurysm in her brain. The nursing challenge herein, therefore, involves the obligation to save the family from further adversities caused by their faith without inordinately infringing on the right to hold on to their faith.
The first theme of the conversation entails letting the family understand their rights and obligations as per the current situation. Due to the brain injury, the patient is no longer able to make personal health decisions hence the obligation to make such decisions falls squarely on the family members. It is also important to inform the family that they have the option to select an ad litem who can make the decisions for and on their behalf (Lord, Livingston, & Cooper, 2015). Finally, it is important to inform the family that even if they do not expressly agree with the professional team, their decisions stand. The next important theme entails informing the family about the precise current situation of their loved one, how it came to be, and the professional expert opinion on the future prognosis on the situation. It is at this stage that bare language without any use of euphemisms or generalizations will be used to tell the family exactly what is going on (Wallace, 2015). In the instant case, it is important to inform the family what being brain dead means and what it entails to live in a permanent vegetative state. A description of what trach and PEG means should also be included.
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The final theme is to inform the family about the available sets of actions that can be undertaken and the possible outcomes of each set of actions. These sets of actions shall then be specifically tied with the different decisions that the family will make. It is at this point that the family should also be made to understand that the decision on the way forward ought to be based on what the patient herself would have chosen if she was able to listen to and understand what has been described above (Lord, Livingston, & Cooper, 2015). This means that it is not about what the daughter want, but rather what the daughter believes their mother would have wanted. An assurance of the support from the clinical teams can then be made in spite of any decisions that the family will make.
The Objectives of the Meeting
The first objective of the meeting is to establish precisely who the ad litem for the patient is; hence who the clinical team shall be relying on for the making of medical decisions for and on behalf of the patient. In different terms, the ad litem should be the person or set of persons who can be able to make the decision that reasonably aligns with those that the patient would have made. The second objective of the meeting is to ensure that the family has a clear layman’s understanding of the patient’s condition (Wallace, 2015). It is not merely enough to explain it out as it is also crucial to ensure that the explanation is unambiguously understood. The third objective is to enable the patient’s family to make rational decisions based on facts that are not inordinately blinded by spirituality or faith. The nature of the instant case is indicative of a common vagary of faith where a treatable condition may have been inadequately managed based on the belief that a miracle healing would happen. A specialist should be able to advise the family on how to avoid such mistakes in future. The specialist should also confirm that the family has understood how to rationalize medical decisions in spite of strong spiritual beliefs. The final objective is to get a decision or in the very least an indication of when a decision about what medical steps will be taken regarding the patient’s condition. When the decision is made, a formula on how it will be implemented should then be developed based on the nature of the decision (Swinton et al., 2017).
Team Members
A team of four individuals would be sufficient in the instant case, including myself as the caregiver. The obligation of the caregiver would be to support the family members and also ensure that everything has been undertaken to protect the interest and autonomy of the patient. The second team member would be the attending doctor who would explain the particulars of the ailment and the options available for the family. The next member would be a counselor, preferably a psychologist who would advise the family members and provide counsel in their trying moment. Finally, there should also be a spiritual advisor, preferably a Baptist minister who would assist on the spiritual aspects of the conversation and also advice the family.
The Script
We are here today to discuss and evaluate the best way forward for your mother Angela Smith who also happens to be our patient. As you are already aware, your mother suffered a ruptured vessel that caused a bleed in the brain, as her doctor will explain to us in more detail. It is the opinion of her medical team that your mother is no longer able to make medical decisions for herself and this situation may not change in future. The aim of this meeting is to establish the way forward for your mum, based on whether she should be subjected to more treatment. We need you as family members to listen to what your mother’s doctor has to say, then inform us on what she would have wanted under the same circumstances had she been making the decision for herself.
References
Lord, K., Livingston, G., & Cooper, C. (2015). A systematic review of barriers and facilitators to and interventions for proxy decision-making by family carers of people with dementia. International Psychogeriatrics , 27 (8), 1301-1312
Swinton, M., Giacomini, M., Toledo, F., Rose, T., Hand-Breckenridge, T., Boyle, A., ... & Cook, D. (2017). Experiences and expressions of spirituality at the end of life in the intensive care unit. American Journal of Respiratory and Critical Care Medicine , 195 (2), 198-204
Wallace, C. L. (2015). Family communication and decision making at the end of life: a literature review. Palliative & Supportive Care , 13 (3), 815-825
