The Case of Casey: Casey’s Last Inning

Casey, a forty-seven year old woman, umpired little league baseball games until she apparently suffered a cardiac arrest six months ago. She suffered anoxic brain damage and is now in a persistent vegetative state. Her mother, who lived with Casey until her illness, insists on aggressive treatment despite the poor prognosis. The nursing home staff has reluctantly agreed to CPR.

About midnight, staff discover Casey to be without pulse or respiration. Medics are called (911) and the rescue squad arrives within six minutes. During this time the nursing staff initiate CPR. After twenty minutes of unsuccessful resuscitation, Casey's physician is called for instructions. The doctor orders that the resuscitation efforts be continued, and that Casey be transported to a nearby emergency room. The nursing staff is reluctant to carry out this order. The rescue squad is willing to proceed. The physician is not willing to come to the nursing home to supervise the resuscitation attempt.

 

Questions

  1. When Casey was transferred from the hospital to the long-term care facility, a window of opportunity to discuss treatment redirection was apparently missed. Create the conversation that could have taken place.

 

  1. As the director of nursing on the night shift, you are the one who calls the physician for instructions. How might you be more assertive in this exchange?

 

Reflecting on Cases involving Moral Distress

Each case should be analyzed according to its particular merits and context. The following questions, however, will help individuals or ethics committees clarify the nature of the conflict, the impasse, and the sort of moral distress that characterizes each situation. 

  1. Have the healthcare providers clearly stated what they believe is the right and good and wise action that ought to be taken for the patient?

 

  1. Has the barrier (persons, rules, policies) to taking the right, good and wise action also been named?

The following questions test whether adequate attempts have been made to deal with the moral distress created by the conflicting goods:

 

  1. What strategies for implementing the right, good and wise action, including compromise, have been carefully considered and weighed for their potential?

 

  1. Before you give up in "moral despair" ask if there is someone outside the situation who can break the impasse.

 

These questions are important elements in all ethical deliberation.

 

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