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Bereavement Care in ICU: Navigating End-of-Life Decisions for Patients and Families

This case study explores the complex process of bereavement care for Mr. Chan, a 78-year-old man facing critical heart failure and pneumonia in the ICU. We delve into the ethical considerations surrounding the withdrawal of life-sustaining treatment and the role of family communication. By using a structured approach, including information gathering and family meetings, we emphasize the importance of meeting the needs of families during this challenging time. This case illustrates how holistic care, focusing on both quality and quantity of life, can support families in making difficult decisions.

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Bereavement Care in ICU: Navigating End-of-Life Decisions for Patients and Families

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  1. Prepared by Ng Kit Yee Bereavement care in Intensive Care Setting

  2. Case • Mr. Chan, 78 years old, male • Healthy all along except Myocardial infarction (heart attack) occurred a year ago • Well-controlled with regular follow up and medication

  3. Case (con’t) • A week ago : • developed generalized weakness and chest pain • Only seek for G.P. and received for mile analgesic

  4. Case (con’t) • Two-day late • Conditions deteriorated and experienced shortness of breath and syncope • After investigation, admitted to ICU

  5. Case (con’t) • After 20hrs • in refectory ventricular tachycardiac (arrhythmia), his cardioverted was correct by defibrillation. • intubated and placed on ventilator, remained in semi-conscious state. • Supportive medications were added

  6. Case (con’t) • He was diagnosed with heart failure and pneumonia. • Complications: • adult respiratory distress syndrome (ARDS) • acute renal failure

  7. Case (con’t) • Decision • withdraw further treatment • do not resuscitate. • At time • weaned from life support measures • died one day after.

  8. Problem • How to discuss with family for withhold life-sustaining treatment, dying and death in Intensive Care setting? • Could the family make the medical treatment decision? • Was it ethical withdraw life support? • Is euthanasia required in such situation?

  9. Communication • Stage 1 • information gathering • Stage 2 • Planning • Stage 3 • Plan-Do-Check-Act(PDCA) cycle

  10. First meeting • Family input • less pain • Action • avoid invasive devices • pain management protocols

  11. Second meeting • Family input • requested more time with patient • Action • unrestricted visiting • placed minimal familiar home object at patient’s bedside

  12. Third meeting • Family input • make decision for withdraw treatment • do-not resuscitation • Action • offer our presence • encourage family communication

  13. Most important needs for family • To be with the patient • To be helpful to the dying patient • To be informed of the dying person’s changing conditions • To be understand what is being do to the patient and why • To be comfort

  14. Most important needs for family • To ventilate emotions • To be comforted and supported • by family members • To be assured that their decision were right • To be accepted, supported and comforted by health professionals • ( Truog & et al, 2001)

  15. Ethical principle involved • Patient autonomy • Nonmaleficience • Quality of life judgement • Fidelity

  16. Conclusion Cure should be looked as holistically, with quality being given same emphasis as quantity Plato

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