Mr. Clayton Khang, a healthy, active married 63-year-old Hmong man with two adult daughters, undergoes percutaneous transluminal coronary angioplasty. Suddenly, the monitors blare – Mr. Khang’s heart has stopped during the procedure. As emergency staff run into the room, the doctor repeatedly shocks the patient’s heart and pounds on his chest. Mr. Khang is quickly wheeled into the operating room so that the torn coronary vessel can be repaired and the blood flow restored to his body.
Following heroic efforts to save his life, Mr. Khang is comatose with nonspecific responses to pain. His family is distraught. Over the next few days, the patient progresses into oliguric renal failure with a need for hemodialysis. His neurologic status remains unchanged and his prognosis for recovery is considered very poor. However, after discussing long-term treatment and code status, his family rejects the suggestion of a DNR and opts for continuing aggressive treatment in the ICU.
One week later, Mr. Khang remains comatose, his life sustained by mechanical ventilation and dialysis. A neurologist confirms the bleak prognosis for a return to a conscious state. The patient’s family, however, insists on maximal therapy. “Dad’s a fighter,” they say. “We can’t give up on him. Do everything.” So, Mr. Khang remains in a deep coma in the ICU. During this time, he develops sepsis, a GI bleed requiring transfusion, fluid overload, and seizures.
Frustrated with the circumstances, the care team places a request for an ethics consult. You are the are the on-call ethicist. What do you recommend?
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