any age is traumatic that includes nurses, physicians, for families, but caring for dying social workers, chaplains, child- children is especially challeng- life specialists, and volunteers. ing. As children and their fami- Among the ethical issues they withhold and/or withdraw medi- cal treatment, the implementa- tion of do-not-resuscitate orders, and allocation of resources. In all circumstances the key to achiev- ing the most positive outcome is to prevent ethical issues from
Continued on the next page lies struggle to deal with their emotional stress, they can ben- e t from the presence of, and services provided by a trusted interdisciplinary healthcare team confront are what, when, and how much medical care a child should receive. In Katy’s …show more content…
It provides a practical approach to ensure effective communication and understanding, to identify the pertinent facts and values in any clinical situation, and to facilitate the discussion and resolution of ethical issues. In the Four Box Method, every clinical case can be analyzed by means of four topics: Medical Indications, Patient Preferences, Quality of Life and Contextual Features. MediCal indiCations refer to the medical evidence for or against the use of diagnostic and therapeutic resources to save life, restore health and function, prevent death, and/or assist in a peaceful death. In Katy’s case, the team should fully understand her medical diagnosis, treatment options and prognosis. What are the goals of Katy’s treatment? What are the probabilities of success? What will happen in case of failure? Each of these questions should be answered rst in a team meeting and then in a discussion with Katy’s …show more content…
Cultural and religious considerations also impact decision making. Katy’s parents’ different religious and cultural backgrounds may in uence their perceptions regarding the bene ts of palliative care. The team needs to reconcile these differences into a uni ed treat- ment plan that is in Katy’s best interest.
Ethical issues are present in every clinical situation. The key is to prevent ethical issues from becoming strife-ridden ethical dilemmas. Using the Four Box Method, open communication and rational decision making become possible, resulting in the resolution of ethical issues and the production of an opti- mal treatment plan bene ting the child, family and healthcare team at the end of a child’s life.
In Katy’s situation, the entire team consulted with her parents and resolved the many dif cult issues generated by Katy’s life and death, including her father’s fear that if he did not pursue ag- gressive medical treatment, he would not be ful lling his role as a parent. The team, acknowl- edging the pain and anxiety of the situation, reassured him that palliative care was in Katy’s best interest and that the family would continue to be supported throughout Katy’s death and be- reavement. Katy was discharged two days later with home hospice and died peacefully two months later, surrounded by her family.