This week, we consider the ethics of a critically ill transplant patient, hope for schizophrenia patients, and a surprising case study.
The Emotions and Ethics of Prolonged Critical Care
A complicated case of a critically ill transplant patient underscores the emotional and ethical struggles healthcare workers must contend with when further medical interventions appear hopeless.
Ms. A, a 62-year-old woman with idiopathic pulmonary fibrosis, underwent a bilateral lung transplant but suffered severe complications – including multiple infections and renal failure – that forced caregivers to put her on prolonged ventilatory support. Nine months after the initial transplant procedure, she remained in the ICU. All the while, her family clung to her slim hopes for recovery.
Her frustrated medical team, including specialists from multiple disciplines, grappled with guilt and moral distress. Some questioned the need to keep pursuing aggressive interventions, convinced that survival was unlikely. Others appeared to be more optimistic.
The case also raised concerns about whether institutional transplant survival metrics – or at least the pressure to preserve them – influenced the team’s decisions.
This scenario highlights the challenges healthcare providers face when patient prognosis is uncertain, families are conflicted, and the patient’s wishes remain a mystery. Clinicians might even experience distressing thoughts of wishing for a patient’s death — not out of any sense of malice – but from a persistent feeling of helplessness and overwhelming concern to ease the patient’s suffering. Recognizing and addressing these emotions without judgment can help medical teams navigate ethical dilemmas like this more effectively.
Multidisciplinary collaboration, ethics consultations, and open discussions about medical futility can support decision-making and prevent burnout. Ultimately, prioritizing both patient-centered care and healthcare provider well-being can lead to better outcomes for everyone.
IN OTHER PSYCHIATRY AND NEUROLOGY NEWS
- Research in The Journal of Clinical Psychiatry shows that, in pooled analyses, schizophrenia patients tolerated xanomeline/trospium well.
- A PPC case report explores the case of a 55-year-old man admitted to the ED for behavioral changes, posing a risk to himself and others, and refusing medical assistance. A CT scan showed surprising results.
- JCP also has a meta-analysis that shows omega-3 polyunsaturated fatty acids (PUFAs) could have potential benefits for ADHD patients.
- PCC also reports this week on a schizophrenia patient with significant aggression who achieved remission with a low clozapine dose.
- Finally, researchers wonder if there could be a biological path to adolescent suicide.
