It's been awhile... How about another ethics question?

  1. 0
    Oooo... I'm openin' a can of worms!

    26 yo G8 P6(none of which live with her), Hx of DA, ETOH,yada yada..... comes to ER with cramping after a night of doing crack and drinking.
    Delivers her 23? weeker there which the residents go all out, gung ho, to save despite the fact this kid is probably 22 weeks (480 g eyes fused and hey? Are those testes yet?)
    We now have an oscillated, dopa, dobut, maxed out fetus with b/l Grade IV bleeds.
    This is probably more of a rant, but do you think this was the right thing for this mother and child? I see this crap all the time and am really sick of it! AARRGGHH!!
  2. 12 Comments so far...

  3. 0
    What a sad case. Sounds to me like this poor baby needs to just have comfort measures. This baby will probably not have any quality of life. We can't save them all.

    Heather
  4. 0
    No
    Ethically, aggressive treatment seems cruel.
    She was miscarrying.
    Now the criminal justice system will punish her. adding insult to injury.
    I dont have any answers.
  5. 0
    Further tx on the babe is unnecessary and cruel, he should be allowed to go. What kind of quality of life will he have? Am I right in thinking that this child is a ward of court? Was a UDS done? What this mother did is criminal, maybe if she is in jail she won't have any more babies. Chances are she went into labor because of the drugs.

    Can the hospital ethics committee get involved, to discuss this case?
  6. 0
    I agree with you, dawngloves. But in my experience, it may be a case of CYA on the physicians' part. A number of years ago, we had a mom come in at about 24 weeks, high on crack, trying to self abort. The baby was septic, had severe RDS (pre-surfactant days), and a laundry list of drugs in his system. He got maximal support for the pathetic 8 hours he lived, and we got slapped with a lawsuit. I wonder if that is the mindset of your physicians. How terribly sad.
  7. 1
    Check and see if there's a corporate motto, something like: "No fetus'll beat us"?

    Sorry, had to let that out, very inappropriate.

    tough dilemma, very true. I would ask for an Ethics Consult, if you have an Ethics Committee in the hospital. At our hospital, ANY member of the team could ask for one, it did NOT have to be a doc.

    Then, sit down, w/ the entire team, including the parent, and lay it out for her. IMHO, knowing VERY little about the case other than what you've said, is that the best option would be to take the baby off the vent, go to a quiet room, and have mom (or RN) hold the baby. Warn her the baby may gasp. You can give some MS if ordered, but you shouldn't [ethically and legally] give them a paralytic agent.

    Don't be surprised if that doesn't happen. Sorry.
    DeLanaHarvickWannabe likes this.
  8. 1
    Dawngloves, do you work with me?????? This is so typical where I work also. I don't think our hospital must have an ethics committee--I sure know they don't darken the doors of the NICU!!!! I often chant "We're all going to hell!!!!!" to the tune of my choice as my theme song for work. I've suggessted that if we would hand out coupons from Wendy's for "free fries (or even crack, for that matter) if you agree to get your tubes tied while in the hospital" we could do a great service for the world.....
    DeLanaHarvickWannabe likes this.
  9. 0
    Originally posted by prmenrs
    Check and see if there's a corporate motto, something like: "No fetus'll beat us"?


    :roll I think you're right!!!! I swear, the next time I see this I WILL go to the ethics committee. I'm in a teaching hospital, but PLEASE!!! How about a lesson in letting go?! I'm as "right to life" as the next guy, but there is a limit.
    I'd be surpise if this little guy lived the night. I almost pray he slips away. Tired of torturing these kids.
  10. 0
    Originally posted by IttyBittyBabyRN
    I've suggessted that if we would hand out coupons from Wendy's for "free fries (or even crack, for that matter) if you agree to get your tubes tied while in the hospital" we could do a great service for the world.....
    I remember in CA the big uproar because a group was offering free tubal ligations and paying you cash! "People" felt it was wrong.
  11. 0
    The joy of working in a NICU...and I love...NO FETUS WILL BEAT US! I think I will make Tshirts for our whole staff LOL

    Neonatologists have a hard time admitting defeat. That kid would be a nice long term nasty chronic in our unit.

    We have an ethics committee, but truth be had, most of the time they aren't much help with the micronates.


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