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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Should we enact a slow code for this neonate?

Malik was born at 32 weeks gestation after an otherwise unremarkable pregnancy to parents of Iranian descent who identify as Shia Muslim. Malik had Respiratory Distress Syndrome and required mechanical ventilation until day five, with nasal continuous positive airway pressure for an additional four days. After three weeks the team noticed he had a distended abdomen and his clinical status deteriorated to the point of reintubation. After an evaluation, the team discovered a malignancy involving his small bowel, liver, diaphragm, and abdominal wall. The pediatric oncologist was consulted by the NICU. She determined that the prognosis was very poor, and that infants diagnosed with this kind of aggressive malignancy usually lived only two months. She explained to the parents that there are no long-term survivors known in the literature, but that she’d reach out to an authority on this malignancy at another medical center who may know more. This authority confirmed the dismal prognosis and recommends against chemotherapy or other aggressive...
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