The case of Father Mac James

| December 14, 2015

Consider Father Mac James, a patient on dialysis following nephrectomy for renal carcinoma. Because of congenital cysts in his other kidney it was expected that he would have to remain on dialysis for life. At one point he became clinically depressed and was successfully treated with electroconvulsive therapy when medications failed to be effective. At the time, he felt that he wanted to “give up,” but also felt an obligation as a retired priest to accept treatment. For two years, despite suffering from postdepression, he continued with dialysis. One day, when the CNS visiting nurse, Abby Davids, saw him, he told her that he wanted to stop dialysis on July 23, following his 40th anniversary as a priest. He said that his quality of life was unacceptable, would not improve, and that he had lived long enough. He said he had “a sense of peace” about his decision. His family was deeply distressed and tried to coerce him into change his mind. After all, “he isn’t that old,” they said. The physicians started antidepressant medication, but to no effect; he did not change his mind. In the clinical care conference, all parties were agreed that they wanted Father Mac to continue his dialysis, except Abby. She has had several discussions with him and believes that his was a reasoned, reflective position, consistent with his beliefs and values, even if he could live a number of years longer on dialysis. However, at the patient care conference, she felt the full weight of the consensus against her. Should she speak up?

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