title: Medicine versus religion in the surgical intensive care unit: who is in charge?
abstract: The chief of surgery at a large academic medical center is approached by a vascular surgical faculty member. After a repair of an aortic dissection, an elderly man has remained comatose and has worsened over several weeks, developing multiple system organ failure. Statistically, his chance of leaving the hospital alive is <1%. The family is deeply religious, and the minister and various elders, deacons, and members of their church have been vigilant in constant prayerful attendance. The attending's tactful suggestions that the time is coming when nature should be allowed to take its course was not well received. The family and their support group are convinced that their fervor will summon a miracle. A large group complained to patient affairs and was taken to the medical center director's office. Today, the director told the attending that the hospital would absorb the overall cost until the patient dies and that the unfavorable press from stopping care is unacceptable. The chief of surgery should:
authors.affiliation: The Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX, USA. jwjones@bcm.tmc.edu
authors.forename: James W
authors.initials: JW
authors.lastname: Jones
authors.forename: Laurence B
authors.initials: LB
authors.lastname: McCullough
mesh_terms: D000046:Academic Medical Centers / Q000941:ethics; D000784:Aortic Dissection / Q000601:surgery*; D001014:Aortic Aneurysm / Q000601:surgery*; D003128:Coma / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D003422:Critical Care / Q000191:economics / Q000941:ethics* / Q000458:organization & administration; D004644:Emotions; D017721:Hospital Costs; D006801:Humans; D007362:Intensive Care Units / Q000941:ethics; D008297:Male; D009102:Multiple Organ Failure / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D011050:Policy Making; D011368:Professional-Family Relations; D012068:Religion and Medicine; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects* / Q000401:mortality; D028761:Withholding Treatment / Q000191:economics / Q000941:ethics*