Nurse and Physician Argument on Whether to Stop Care

Nine-year-old Yusef Camp began experiencing symptoms soon after eating a pickle bought from a street vendor. He felt dizzy and fell down, he could not use his legs, and he began to scream. By 10:00 p.m., he was hallucinating and was transported to the DC General Hospital by ambulance. He went into convulsions. His stomach was pumped, and they found traces of marijuana and possibly PCP. He soon stopped breathing, and by the next morning, brain scans showed no activity. Four months later, Yusef’s condition had not changed. The physicians believed his brain was not functioning and wanted to pronounce him dead based on brain criteria. Several difficulties were encountered, however. First, there was some disagreement among the medical personnel over whether his brain function had ceased completely. Second, at that time the District of Columbia had no law authorizing death pronouncement based on brain criteria. It was not clear that physicians could use death as grounds for stopping treatment. Most important, Ronald Camp, the boy’s father, protested vigorously any suggestion that treatment be stopped. A devout Muslim, he said, “I could walk up and say unplug him; but for the rest of my life I would be thinking, was I too hasty? Could he have recovered if I had given it another 6 months or a year? I’m leaving it in Almighty God’s hand to let it take whatever flow it will.” The nurses involved in Yusef’s care faced several problems. Maggots were found growing in Yusef’s lungs and nasal passages. His right foot and ankle became gangrenous. He showed no response to noises or painful stimuli. The nurses had the responsibility not only for maintaining the respiratory tract and the gangrenous limb, but also for providing the intensive nursing care needed to maintain Yusef in debilitated condition on life support systems. Had the aggressive care been serving any purpose, they would have been willing to provide it no matter how repulsive the boy’s condition was and in spite of there being many other patients desperately needing their attention. However, some of the nurses caring for Yusef were convinced that they were doing no good whatsoever for the boy. They believed they were only consuming enormous amounts of time and hospital resources in what appeared to be a futile effort. In the process, other patients were not getting as much care as would certainly be of benefit to them. Could the nurses or the physicians argue that care should be stopped because he was dead? Could they overrule the parents’ judgment about the usefulness of the treatment even if he were not dead? Could they legitimately take into account the welfare of the other patients and the enormous costs involved when deciding whether to limit their attention to Yusef?