Mr. Kind is a 71-year-old man with multi-system organ failure. Presently, his kidneys are not functioning appropriately. However, his underlying problem is non-small cell lung cancer with metastases to the liver. He has been unconscious in this most recent hospitalization for more than five days. Fluid is accumulating around his heart and within the last 24 hours he was placed on mechanical ventilation. This is the third hospitalization at All Saints Hospital for Mr. Kind. His first resulted in physician requests to make him a "no code" and to limit the extent of aggressive technological interventions and instead focus solely on comfort care. Mr. Kind's three daughters, all of whom are single and have quit work to live with and care for their father, refuse to believe that their father is dying and think that if only appropriate medical interventions are given he will go home and live peacefully for some months, if not years.
After Mr. Kind's daughters took him home following his first hospitalization, Mr. Kind seemed to stabilize for a short period of time, but then was hospitalized again with similar complications. Physicians and hospital staff took the same course of action and again requested a DNR order and minimal technological and intensive care use, only to have all of these requests denied by the daughters. The daughters have learned how to provide excellent home care and despite their father's limited mobility, he is free from infection, bedsores, and any other medical difficulties.
The third and most recent hospitalization was caused by an increase in respiratory difficulty and an increasing lethargy and unresponsiveness. Again, physicians are requesting that Mr. Kind be made a "no code" and that he be removed from the intensive care unit and be given only comfort measures. The daughters believe these requests are financially motivated and are disrespectful to the dignity of their father. They even said that if their father were not resuscitated upon arresting, they would bring a wrongful death suit against the hospital as well as the participating physicians and nurses. Periodically, they invoke their Catholic faith in support of their requests, but are unable to elaborate on the elements of their faith that would require such a course of action. (Courtesy of Dr. Michael Panicola, SSM Health Care, St. Louis, Mo.).