Baby Moshe was born more than four months early and weighing 500g. At 23 weeks’ gestation, his moist, sticky skin painfully lifts off upon contact and leaves 1st degree burns. Baby Moshe is unable to breathe on his own and is currently on a ventilator and suffering from seizures. At four days old, there is a significant risk of a bowel breakdown, collapsed lungs, inter-cranial bleeds and multiple system failures, each requiring intrusive testing and treatments with unpredictable results. Early this morning, Baby Moshe suffered a collapsed lung, which resulted in irreparable brain damage. Baby Moshe appears to be in a PVS state, and is unable to control breathing or maintain blood pressure and blood volume without mechanical interventions. Dr. Feutile, the Neonatologist, believes that under the Whole Brain Death definition, Baby Moshe is dead and should be removed from the ventilator. Baby Moshe’s parents, Mr. and Mrs. Hope strongly disagree. As devote Orthodox Jews, they believe that life is breath. As long as Baby Moshe is ‘breathing,’ and his heart is pumping, whether through mechanical supports or on his own, he is alive. The Hopes’ refuse Dr. Feutile’s request to conduct more tests to determine whether Baby Moshe fits the Whole Brain Death criteria, reasoning that the ‘unnecessary’ procedures will cause their son pointless suffering and the results irrelevant.
Frustrated at the irresponsible use of resources, and struggling with his spiritual beliefs that the dead should be buried and honored rather than being preserved in a hospital bed, Dr. Feutile calls for an Ethics consult.
*The case study is a fictitious composite of real-life scenarios.
Read the following and then participate in the Best Interests and Baby Moshe Discussion:
•Module notes and textbook pages
•Kon, A. A. (2010). The shared decision-making continuum. JAMA, 304(8), 903-904.
•Kopelman, L. (2007). The best interests’ standard for incompetent or incapacitated persons of all ages. Journal Of Law, Medicine & Ethics, 35(1), 187-196.
•Drolet, MD, B. & White, MD, MA, C. (2012, July). Op-Ed: Selective paternalism. Virtual Mentor American Medical Association Journal of Ethics, 14(7), 582-588. Retrieved from http://virtualmentor.ama-assn.org/2012/07/pdf/oped2-1207.pdf
Read the following scenario and participate in the discussion:
You are a member of the hospital Ethics committee. At the meeting, the Chairman asks you to discuss the following two questions:
a.Presuming for argument’s sake that the Hope’s have decision making authority for Baby Moshe, and taking their religious beliefs into account, how should their decision to refuse Dr. Fuetile’s tests be assessed under the Best Interests standard?
b.Presuming that Dr. Fuetile plans to seek judicial support, how might shared decision making be applied in order to diffuse and address the conflicts over Baby Moshe’s care?