David P. Schenck

In Search of a Good Death

Spirituality and storytelling can be resources in aging successfully and in dying well given the constraints of modern day Western culture. This paper explores the relationship of aging to time and the dynamic process of the life course and discusses issues related to confronting mortality, including suffering, finitude, spirituality, and spiritual closure in regard to death. And, finally, the role of narrative in this process is taken up.

Case 14—To Treat…or Not to Treat?

This case involves an unfunded patient with advanced head and neck cancer, complex medical care needs, and no safe plan for discharge. To what extent physicians have an obligation to present all possible treatment options is discussed, along with hospitals’ responsibilities to insure a safe discharge plan for indigent patients.

Case 13—Are There Limits on Futile Care for Patients in the U.S. Illegally?

This case examines the complex issues in caring for a patient in the U.S. illegally who was involved in a motor vehicle accident. He was diagnosed as being in a persistent vegetative state, and proxy decision-making was complicated by his illegal immigration and marital status, and by his estranged relationship with his mother in Mexico.

Case 9—When Parents Contest an Adult Child’s Advance Directive

The patient was a 25-year-old woman admitted to the hospital from hospice care with end-stage cardiomyopathy. She had an advance directive which specified a limited trial of ventilator support, which the patient’s schizophrenic mother successfully contested in court.

Case 11—Who Should Make Treatment Decisions for a Battered Spouse?

The health care team struggled with how to reconcile American law, Western medical ethics, and their own cultural values when a woman who as a Chinese immigrant was brought to the hospital after being brutally beaten by her husband, and her husband is permitted, at least initially, to act as her proxy decision maker.

Case 5—Is There Life After Death? A Case of Post-mortem Sperm Retrieval

A young widow asked her late husband’s physicians to retrieve his sperm posthumously so she could conceive a child in his memory, then changed her mind when she fell in love with another man.

Case 3—When the Family Won’t Decide

A teenage mother gave birth to a baby with multiple congenital abnormalities including alobar holoprosencephaly (where the brain does not develop into left and right lobes), cleft lip/palate, severe gastro-esophageal reflux, failure to thrive, and seizure disorder. The babys young parents each lived with their own parents, and refused to make medical decisions or communicate with the medical team.

Case 1—Does the Nearness of Death Diminish the Value of a Life?

A sex worker who was pregnant with her fourth child was diagnosed with a fatal tongue tumor. Balancing her treatment preferences along with the needs of her unborn child were further complicated by difficult family relationships and a history of poor access to health care resources.

Case 6—What Is the Standard of Care for a Corpse?

A mother inadvertently gave her young daughter expired insulin and told the Emergency Department physicians only that her daughter was experiencing flu-like symptoms. She refused to allow her daughter to be removed from life support even after she was declared brain dead, and threatened the hospital with a lawsuit for failing to accurately diagnose her daughter’s condition in a timely way.

Case 16—A Depressed Caregiver Neglects His Own Health

A man who had been caring for his disabled wife for over 50 years neglected his own health, and his family needed to make a series of medical and other decisions on behalf of him and his wife, often without sufficient documentation or information.