Family Disagreement

Ms T was found unresponsive at home in April 2014. Paramedics were called and CPR was performed. She was intubated in the Emergency Department. Ventricular fibrillation was indicated as the cause of the cardiorespiratory collapse. CT brain scan showed a brain tumour — likely a meningioma. Ms T has been unconscious since her collapse due to hypoxic encephalopathy.

She also has a complete heart block, which required the placement of a temporary pacemaker. She is not brain dead because she failed one of the criteria for brain death. However, she is ventilator dependent.

Ms T’s poor prognosis was communicated to the family and an end of life discussion held. They are unable to agree on what to do next. Madam T’s husband and children think life support should be withdrawn, following the advice from the medical team that treatment will only prolong the dying process. Ms T’s siblings however wish to continue life support and active treatment.

Ms T does not have an Advance Care Plan or an Advance Medical Directive, and she has not expressed any preferences verbally to her family members.

This case was originally designed for the 2016 CENTRES clinical ethics conference.