Reference no: EM133656211

Question

One Monday morning as John Krescher, a medical technologist, is going into the intensive care unit (I.C.U.) to draw blood samples on a patient, Mr. Lacey, he is stopped by Mr. Lacey's daughter. John has seen her there often, at her father's bedside, although they have not had any lengthy discussions about Mr. Lacey. This morning she says, angrily, that Dr. McNally is planning to transfer her father prematurely to the general medical floor. She and her husband are threatening suit against the hospital unless Mr. Lacey is allowed to remain in the I.C.U. and receive the fullest medical care there. John expresses his surprise and is about to ask some further questions, but she rushed out of the unit, apparently on the verge of tears. John goes over to Mr. Lacey's bedside and puts his hand on the man's shoulder. He studies Mr. Lacey's face for some sign of response, but there is none. John' s mind is flooded with thoughts. Mr. Lacey is a 70-year-old white man who is retired from the civil service, where he worked as a mailman. Initially he was admitted to the hospital complaining of severe abdominal pain. After several days of tests and exploratory laparotomy was performed. An ischemic segment of bowel was resected. In the post-operative suite he suffered a respiratory arrest and was transferred to the I.C.U. Since that time, 8 weeks ago, he has been in a fluctuating level of coma, and has never fully regained consciousness. Mr. Lacey has had a stormy course characterized by multiple serious medical complications. He developed a severe systemic infection about 6 weeks ago at which time it was thought he would die. He was treated with massive doses of antibiotics and recovered. But the antibiotics were severely toxic to the kidneys. He is now showing signs of renal failure which will necessitate dialysis. The entire health care team has become progressively more pessimistic about Mr. Lacey's prognosis. He has been almost totally unresponsive for the last 2 or 3 weeks. John was involved in the I.C.U. rounds 2 days ago in which Mr. McNally shared with the staff that he had several discussions with the family, and had tried to explain tot hem the unlikelihood that Mr. Lacey's condition would improve or that he would ever regain consciousness. "But," Dr. McNally said, "they wish aggressive treatment as long as there is any hope of meaningful recovery or survival." Dr. McNally also reminded the team of Mrs. Lacey's recent dramatic recovery from a myocardial infarction (heart attack) in which she suffered a cardiac arrest and was successfully resuscitated, and that the family now hoped for a similar miraculous recovery for their father. Mr. Lacey had left no Living Will, and had never expressed an opinion about long-term life support. John goes to the I.C.U. desk and greets the nurse, Janet Cumming. Janet says, "Mr. Lacey's daughter is so upset because Dr. McNally has decided to discontinue intensive care therapy in spite of the family's objections. We will be transferring him back to the ward later today. My guess is that he will die within a week..."

1. Should care be continued in the I.C.U. because of threat of a lawsuit?

2. Should Mr. Lacey be continued in the I.C.U. because the family has a right to demand continued treatment of this sort?

3. Should Dr. McNally be dismissed from the case because he has treated Mr. Lacey for too long and his judgment is impaired?

4. Should Dr. McNally explain to the family how unreasonable their demands are because of the high cost of this type of treatment?

5. Should Mr. Lacey be transferred because he has already used up too many resources?

Review two other discussion board postings and comment on similarities and differences in your evaluation of this case study.