Director of respiratory therapy at a large regional medical center.

You are the director of respiratory therapy at a large regional medical center. There is an 85-year-old female Hispanic patient in the adult intensive care unit. The admitting diagnosis for the patient is “stroke.” Prior to admission, the patient had a history of heart and pulmonary problems and lung cancer (successfully treated by surgery and radiation 10 years ago). Tests conducted since admission have discovered early-stage liver cancer. The patient has been in a comatose state ever since admission, unable to communicate or move. Since the patient is unable to breathe on her own, she is also on a ventilator.

The patient was admitted 15 days ago; she is without insurance and has no proof of citizenship. The hospital business office wants to know if she can be discharged from AICU, which costs the hospital $20,000 per day, or if the family will agree to disconnect the ventilator. The attending physician is new on the medical staff and is unsure of the patient’s prognosis.

The AICU is full, so the discharge planner is under pressure from his supervisor to free up the bed needed for other critical patients. The patient’s family is strongly against withdrawal of any life support or reducing any care standard. They have been adamant that God will perform a miracle and the patient will walk out of the hospital. The patient’s children are all adults, natural-born citizens of the U.S. who own a successful, well-known local business.

A local TV station has been ‘covering the story’ although they have not publicly disclosed the patient’s name. The state governor has come out publicly stating that illegal aliens are a drain on our state’s resources and should be sent back to their countries of origin. The governor’s challenger (whose daughter is a nursing student in AICU) says there is a moral duty to care for everyone.

You are scheduled to meet with the hospital ethics committee tomorrow. After the meeting, you, the physician, and the AICU chaplain are to meet with the patient’s family regarding the patient’s course of care. How will you prepare for the upcoming meeting with the hospital ethics committee? What issues do you expect will come up during that meeting? What will you say to the patient’s family?