12. CASE: Should Steve Go Home?

Throughout his life, Steve was the athlete that everyone admired. He played all sports well, especially excelling at basketball. While being quite competitive, Steve was a team player who enjoyed being a part of the team experience.

Unfortunately, while ‘horsing around’ with his friends last summer, Steve dove off a dock into water that was too shallow. His head cracked on the bottom resulting in a spinal cord injury. He is no longer able to walk and has slowly been regaining some control over a few of his fingers.

At 17, Steve felt that his life was over and has had difficulties participating in his rehabilitation program, saying things like, “What’s the point if I’m never going to walk again?” and, “I can’t even go to the bathroom by myself!”

Steve’s family, friends, and health care team rallied around him providing lots of support and encouragement. Over the past month-and-a-half, the health care team noticed some positive changes in Steve’s involvement in his rehabilitation program. He is participating more and talking about wanting to get out of the rehab facility. Accordingly, the health care team was working with Steve on a discharge plan in three weeks, if his progress continued. All of this seemed to indicate that Steve was beginning to see a new life for himself – until one of the Recreation Therapists came to the team meeting three days ago.

Steve and Andrea, the Rec Therapist, developed a close working relationship over his time at the rehab facility. Steve often shared with Andrea what he was really thinking and this has been helpful for the health care team to identify what interventions and supports may be needed. Steve confided to Andrea (three days ago) that the only reason that he was working so hard at learning to use his motorized wheelchair was so that he could control the joystick well enough to ensure that he could kill himself by driving off the same dock where his injury occurred.

A consult with a psychiatrist who specializes in persons with spinal cord injuries reports that Steve is not depressed and does not seem to have the intent to follow through with his plan of suicide. He said that this expression may have been primarily an indication of Steve’s ongoing frustration and adjustment to his spinal cord injury.

Even with this information, the team is conflicted about what to do. Their own hopes that they were making progress with Steve have been challenged too. The team agrees to consult the ethics support service.

  • How would you handle this request?
  • What values appear to be shaping the dynamic for team members? For Steve?
  • What are the ethics concerns?
  • How should the health care team reconcile the difference in opinion between the psychiatrist and those who believe Steve’s plan to commit suicide?

 

Some Values and Ethics Issues to Consider

  • Capacity
  • Respect for patient autonomy
  • Moral distress of health care providers
  • Respect for professional integrity
  • Honesty, trust and truth-telling
  • Patient-provider relationships
  • Compliance with policy
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