Friday, August 18, 2006

Your Truth: "I Want to Drive Her Home."

"Your Truth" is a series of posts I have written describing end-of-life scenarios. These scenarios are in some way controversial - either due to an ethical dilemma or a particular communication challenge. Please read the scenario and then offer your thoughts on what you might do in this circumstance. Although these scenarios are all based on real-life situations, they are fictionalized so as to protect the anonymity of the person(s) whom the scenario was inspired by.

In this next scenario, we have a 82 y.o. Russian female who had a stroke that left her non-responsive (she is unable to speak nor move and her gag and corneal reflexes are absent). She had end-stage renal disease prior to the stroke. She is still in the hospital. The doctors have given her a prognosis of days to weeks to live. Her family, per her written advanced directive wishes (rare to have these done, but sometimes we're lucky enough to know what the patient would want), has decided to stop dialysis and start her on hospice care. The family would like to take her home to die.

The family is afraid, however, that she will die during the ambulance ride home. They are strongly opposed to her dying in an ambulance and so they would like to drive her home in their minivan. Despite education regarding the perceived improved comforts that would come with the ambulance ride (bed, pain medicine, gurney ride into the home), the family remain committed to driving her home themselves.

Now keep in mind that the minivan is not equipped with a bed and the patient would have to be phycially lifted into the minivan. Due to hospital liability issues, the nursing supervisor reports no hospital staff may help her into the van and therefore the patient must be transported home by an ambulance.

What might you do? What are the potential positive and negative ramifications of either option?

No comments: