Conflict resolution at the end of life and the role of the ethics consultant

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...
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Living at Risk

Marta is a 73 year-old woman, living in her own apartment. She has early-stage dementia with non-insulin-dependent diabetes (requiring oral medications), mild renal impairment, obesity, and moderate COPD due to previous smoking history.  Her son, Ivan, came to visit after a 10-month absence and was shocked by the state of her apartment. He found a charred saucepan on her stove, garbage that had not been taken out for weeks, a foul-smelling cat litter box, and moulding food in the fridge. He took Marta in to her family doctor to express his concerns about her living situation. Her family doctor completed an assessment that revealed, among other things, that Marta has not been taking her medication reliably and that she has deficits in executive functioning. After determining that Marta lacks decision-making capacity in the areas of health care and accommodation, the family doctor activated Marta’s Personal Directive in these domains. In her Personal Directive, Marta has named Ivan as her Agent...
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Now and Then

Mr. Hendricks is a 58 year old with early-onset dementia that has progressed rapidly in the last three years. He is living in a continuing care facility with a nephew, Frank, as his substitute decision maker. Mr. Hendricks has an advance directive, written twenty years ago, which specifies that if he were to develop dementia he wishes to refuse any interventions aimed at cure, including antibiotics for pneumonia, and states that he would find a life with moderate or advanced dementia not worth living. Cold and flu season is coming up, and staff at the continuing care home are wondering what their responsibility is if Mr. Hendricks develops pneumonia as well as whether Mr. Hendricks should receive the annual flu shot. Their concern is amplified because, contrary to Mr. Hendricks’ expectations, he seems to find considerable pleasure in his life with worsening moderate dementia. Frank, Mr. Hendricks’ nephew, lives two provinces away and says that while they had a loving relationship, he...
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