“God Will Heal My Foot”: Evaluating Religious Aspects of Medical Decision-Making
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a session that every healthcare professional needs to attend! Domain Structure and Processes of Care Case Conference III (429) ‘‘God Will Heal My Foot’’: Evaluating Religious Aspects of Medical Decision- Making Julie Childers, MD, University of Pittsburgh Medical Center, Pittsburgh, PA. (Childers has disclosed no relevant financial relationships.) Objectives 1. Develop strategies for discussing medical de- cision-making with patients and families who are hoping for a miracle. 2. Discuss ways to ease the burden of family members who must make difficult decisions on behalf of the patient. Mrs. S was a 74-year-old African American woman with a history of diabetes and limited adherence to medical treatment. She was admitted to the hospital with a gangrenous foot from an untreated diabetic ulcer. Despite intravenous antibiotics, the infection progressed, and the surgeons advised her that the only treatment that would save her life would be amputation. However, the patient refused, saying, ‘‘God will heal my foot.’’ The palliative medicine service was consulted to help the patient and family decide if hospice care would be appropriate. Our discussion with Mrs. S revealed that she did believe that God does work through medical treatment and doctors. She was willing to take medications to treat the infection, but to her, am- putation would be against God’s will. She did not want to die and did not think she would die if she refused amputation. To Mrs. S, God’s physical healing of her gangrenous foot was not just a mir- acle to be prayed for, but a certainty. She would not explain further or entertain the possibility that the healing might not take place. Psychiatry assessed that her capacity to understand the con- sequences of her decision was limited. Mrs. S’s stance was consistent with her previous decision-making, reliance on religious faith, and avoidance of medical procedures. Four years pre- viously, Mrs. S had refused an amputation for the same reasons, and her daughter had signed con- sent. Since then, the patient had seemed content to be mobile in wheelchair and enjoyed living with her daughter’s large family. She expressed no resentment against her daughter. However, the patient’s daughter had been haunted by guilt about her decision to go against her mother’s wishes. It was uncertain if Mrs. S would fare as well with both legs amputated, especially as her overall medical condition had worsened. Domain All Domains A Series of Odd Requests: A Closer Look at Grief and Its Impact on the Interdisciplinary Team Alexandra Leigh, MD, University of Alabama at Birmingham, Birmingham, AL. (Leigh has disclosed no relevant financial relationships.) Objectives 1. Discuss the challenge of addressing acute grief in the inpatient setting. 2. Explore how an interdisciplinary team can ad- dress and cope with the sometimes atypical demands that occur during death or impend- ing death. Mrs. C is a 38-year-old who sustained a devastating traumatic brain injury during a motor vehicle ac- cident. On arrival to the ER, her Glasgow Coma score was 4 and she showed posturing behaviors. Despite aggressive care in the intensive care unit (ICU), she had no neurologic recovery and prog- nosis was deemed poor. Her immediate family consisted of her husband, a trial lawyer, and two children, ages 10 and 11. Goals of care discussions were initiated with challenge due to Mr. C’s anger over his wife’s accident and difficulty seeing her in an ICU setting. With time, Mr. C was able to dis- cuss his wife’s condition and elected to transfer her to the inpatient palliative care unit for com- passionate extubation. After arrival to the unit, Mr. C became preoccupied with documenting Mrs. C’s impending death. He set up a continuous video camera in her room to record her time with family members and staff. He became consumed with obtaining moldings of her hands as well as a death mask ‘‘so I can stroke her face. She was my queen.’’ He asked that tattoos of family mem- ber’s names be placed on her body. At the same time, Mr. C would also frequently state, "my wife died the day of the accident; that is just a vessel in the room,’’ while family told their community that Mrs. C had already passed. Furthermore, Mr. C expressed he was planning litigation and wanted to use his video documents during the trial. Multiple palliative care team members, Vol. 39 No. 2 February 2010 Schedule with Abstracts 403
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Transcript of “God Will Heal My Foot”: Evaluating Religious Aspects of Medical Decision-Making
Vol. 39 No. 2 February 2010 Schedule with Abstracts 403
a session that every healthcare professionalneeds to attend!
DomainStructure and Processes of Care
Case Conference III (429)
‘‘God Will Heal My Foot’’: EvaluatingReligious Aspects of Medical Decision-MakingJulie Childers, MD, University of PittsburghMedical Center, Pittsburgh, PA.(Childers has disclosed no relevant financialrelationships.)
Objectives1. Develop strategies for discussing medical de-
cision-making with patients and families whoare hoping for a miracle.
2. Discuss ways to ease the burden of familymembers who must make difficult decisionson behalf of the patient.
Mrs. S was a 74-year-old African American womanwith a history of diabetes and limited adherence tomedical treatment. She was admitted to the hospitalwith a gangrenous foot from an untreated diabeticulcer. Despite intravenous antibiotics, the infectionprogressed, and the surgeons advised her thatthe only treatment that would save her life wouldbe amputation. However, the patient refused, saying,‘‘God will heal my foot.’’ The palliative medicineservice was consulted to help the patient and familydecide if hospice care would be appropriate.Our discussion with Mrs. S revealed that she didbelieve that God does work through medicaltreatment and doctors. She was willing to takemedications to treat the infection, but to her, am-putation would be against God’s will. She did notwant to die and did not think she would die if sherefused amputation. To Mrs. S, God’s physicalhealing of her gangrenous foot was not just a mir-acle to be prayed for, but a certainty. She wouldnot explain further or entertain the possibilitythat the healing might not take place. Psychiatryassessed that her capacity to understand the con-sequences of her decision was limited.Mrs. S’s stance was consistent with her previousdecision-making, reliance on religious faith, andavoidance of medical procedures. Four years pre-viously, Mrs. S had refused an amputation for thesame reasons, and her daughter had signed con-sent. Since then, the patient had seemed contentto be mobile in wheelchair and enjoyed livingwith her daughter’s large family. She expressed
no resentment against her daughter. However,the patient’s daughter had been haunted by guiltabout her decision to go against her mother’swishes. It was uncertain if Mrs. S would fare aswell with both legs amputated, especially as heroverall medical condition had worsened.
DomainAll Domains
A Series of Odd Requests: A Closer Look atGrief and Its Impact on the InterdisciplinaryTeamAlexandra Leigh, MD, University of Alabama atBirmingham, Birmingham, AL.(Leigh has disclosed no relevant financialrelationships.)
Objectives1. Discuss the challenge of addressing acute
grief in the inpatient setting.2. Explore how an interdisciplinary team can ad-
dress and cope with the sometimes atypicaldemands that occur during death or impend-ing death.
Mrs. C is a 38-year-old who sustained a devastatingtraumatic brain injury during a motor vehicle ac-cident. On arrival to the ER, her Glasgow Comascore was 4 and she showed posturing behaviors.Despite aggressive care in the intensive care unit(ICU), she had no neurologic recovery and prog-nosis was deemed poor. Her immediate familyconsisted of her husband, a trial lawyer, and twochildren, ages 10 and 11. Goals of care discussionswere initiated with challenge due to Mr. C’s angerover his wife’s accident and difficulty seeing her inan ICU setting. With time, Mr. C was able to dis-cuss his wife’s condition and elected to transferher to the inpatient palliative care unit for com-passionate extubation. After arrival to the unit,Mr. C became preoccupied with documentingMrs. C’s impending death. He set up a continuousvideo camera in her room to record her time withfamily members and staff. He became consumedwith obtaining moldings of her hands as well asa death mask ‘‘so I can stroke her face. She wasmy queen.’’ He asked that tattoos of family mem-ber’s names be placed on her body. At the sametime, Mr. C would also frequently state, "my wifedied the day of the accident; that is just a vesselin the room,’’ while family told their communitythat Mrs. C had already passed. Furthermore,Mr. C expressed he was planning litigation andwanted to use his video documents during thetrial. Multiple palliative care team members,
