Ms. Bearchild is a 64-year-old woman with end-stage renal disease and moderate dementia. She often experiences paranoia and agitation as a result of her progressing dementia.  The team has involved behavioural consultants and attempted various environmental and staffing changes to reduce some the behavioural symptoms of her dementia, but still, she is often combative and screaming.  Sedation is often used when other methods of calming Ms. Bearchild have failed.  Ms. Bearchild’s two adult children are her substitute decision-makers.

When she attends dialysis, Ms. Bearchild is either actively resisting or she is extremely sedated.  She is not a candidate for kidney transplant.  Due to her resistance and distress, the dialysis team sometimes needs to stop her dialysis runs before completion.  She is experiencing significant fluid build-up. 

The SDMs want dialysis to continue and do not support a comfort care approach.  They wish their mother to remain ‘full code.’  They express concern that the health care team is focusing too much attention on her worst moments, and not sufficiently appreciating the times when she is reasonably content.

The health care team believes that if the patient arrests, attempted resuscitation would be extremely unlikely to restore the patient to her baseline level of function. They express concern that they are “torturing” Ms. Bearchild with continued dialysis, and that intervening with a ‘full code’ response would cause significant harm without compensating benefit. The team asks you to facilitate an ethics consult meeting with the family.