A 26-year-old, 28 weeks pregnant Asian woman

A 26-year-old, 28 weeks pregnant Asian woman underwent ultrasound examinations. The physician who performed the final examination informed the woman that the fetus had a lethal brain malformation. Birth was then induced prematurely not only in accordance with the mother’s wishes, but also because it was considered to give the child a better prognosis. After birth, the child’s condition improved much more positively than anticipated. The woman, however, strongly expressed that she wanted treatment to be withheld. As she verbalized it was her cultural belief not to tamper with life. The physician thought this was unethical. He felt he had a duty to save the life of the child. All the people involved experienced great difficulty in communicating with the mother. In this case the discussion concluded that the absolute and pessimistic (negatively) content of information given to the woman before birth could have induced or strengthened her feeling of hopelessness and rejection of the baby. If the ultrasound findings had been presented with reservation reflecting the uncertainty which always is associated with this kind of information, the mother might more easily have accepted treatment of her child. The prognosis of the child seemed to be so good, it would have been wrong not to treat the child actively. This case is brought to the ethic committee: 1. Does the mother have the right not to treat the child? The mother has the right to not treat the child, however, it makes her ethical decisions seem questionable, especially considering that the child despite not having a great prognosis has been improving very positively. 2. How can the health care team support this mother? Are there any holistic alternatives? Besides surgical treatment is there any supplement that can be given to help with the formation of the baby, maybe slow but may work? Educate the mother that treatment would be necessary for the baby to seek life. Treatment wouldn’t be interfering with life more so promoting it is just like vaccinating a child or giving a child a healthy diet and lifestyle. Education would be key. A good option would be speaking with someone of high power in the religion to give a consultation. Are there any loops? Would the “higher up” be able to consult the mother with the staff as to why she has these beliefs? 3. Who will be involved on the ethics committee and what will be their role in supporting this mother The ethics committee on this case includes the pediatrician, OB, nurse, social worker, psychiatrist, nurse manager, and a lawyer. They’re there to help educate and guide the mother so that she can make the decision that’s best for her and her child. It’s clear in this scenario that miscommunication has played a big role in influencing decisions. Opening up the conversation and making all options clear is vital. A member of her family or religious group may also be there to support the mother when making her decisions. 4. How might cultural and religious influence this mother’s decision Cultural and religious influence have a huge impact/effect on the mother’s decision seeing as she believes and stated that she had a cultural belief to not tamper with life and wanted treatment to be withheld even though the physician found this unethical and proceeded to make the decision to save the child from a lethal brain malformation. But it does state that “birth was then induced prematurely not only in accordance with the mothers wishes “but then vocalized afterwards that it went against her cultural belief. 5. What support from the interprofessional team will be needed? There will need to be a combined effort from a social worker, providers, nurses, and the family to decide what the best course of action is for the child. If anything, they could possibly look into adoption for the child if the child begins to heal well and the mother does not seem to be in the right place to take care of her child and make the best decisions for the child going forward. 6. How could interprofessional teamwork ensure that the patient is the center of care delivery? Interprofessional teamwork ensures that the patient is the center of care delivery because it allows multiple people to focus on which plan of action would be best for them. The collaboration of minds allows proper communication about observations made about the client and relieves pressure so that clear minds can make clear decisions. Each member of the team has different responsibilities that correlate with the patient, so communicating the various needs can help differentiate which would be best for the individual. Seeing the team work together, it is very important that everyone plays their role in communication and delegation of different tasks and decisions, so what is best for the patient is what will be done, but also trying to include the parents in the decision. The nurse, nurse manager, and the provider worked as a team primarily to educate the mom on the current prognosis of their child, and how they felt that it would be unethical to pause any treatment. The OB DR. the OB was impressed with the outcome, and feels that the baby will have a better life than what is usually expected with someone who was born with anencephaly, and that withholding treatment seems unfair and wrong for the child. The social worker played a big role in this case study, because the social worker was the one who had to focus on the more negative “what-if’s” that were presented in this situation. Social Worker: The social worker explained to the mom that the purpose for life is living it to the fullest, continuing treatment, to try to keep the baby at their highest comfort level, however, also discussing the option about signing off on a DNR, with the understanding that if down the line, the quality of life is not suitable for the baby or the parents, then signing off on a DNR may be the best option for everyone involved. Psychiatrist: There is a lot of thinking that goes into this situation, and that is where the psychiatrist comes into play. The psychiatrist had to evaluate the mother’s mental health, because it was necessary for the psychiatrist to understand where the mother is coming from in regards to her knowledge and understanding of the situation. The Lawyer: The lawyer was able to explain the legalities of the situation to the mom and hospital workers, and help the mom further into what she felt was the best decision. The nurses role in this scenario was to continue assessing the patient, and monitoring the progress, and letting the provider know if there were any difficulties or significant changes, which there weren’t. This is why our conclusion was to continue treatment for the baby. : As a member of the Inter professional ethic committee what did you value most? SCIENCE HEALTH SCIENCE NURSING NURSING 2000

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