Response to: 'Medical consent; striking the right balance between shared decision-making and shared responsibility': a win-win scenario if done well.

Abstract

We read with great interest your article ‘Medical consent; striking the right balance between shared decision-making and shared responsibility’.1 It beautifully highlights the balance of shared decision and shared responsibility. The case scenarios dealing with such issues are often faced by doctors leaving them perplexed and unsure. Coronavirus disease 2019 (COVID-19) has further created severe dilemmas and unanswered ethical complexities for the patient management. The grief and anxiety of caregivers are further accentuated by isolation and social pressure. The challenges are even more when patients on palliative care develop severe COVID. Each situation has unique personalized dilemmas and needs appropriate model of care.1–4 The complex decision-making involves the need to balance the right medical decision while empathizing personal choices of the patient with aim for a holistic care of physical, psychological and social health of the patient.2 Every such experience can be unique and contribute to evolving our patient care. We share our experience of a challenging situation in COVID intensive care unit (ICU) when a 14-year-old girl with osteosarcoma bone with lung metastasis was transferred to ICU for severe COVID-19 infection. The challenging situation posed several doubts like fears of ending life away from the family members in hospital versus no treatment at home for severe COVID. The situation in our case was further scarred by the need for critical care unit for rapidly worsening oxygen requirements and an X-ray (Figure 1) revealing a white out lung which prognosticated towards grim outlook. A team of ICU specialists, paediatricians, palliative care physicians and family together decided to make a shared decision. A shared decision to avoid aggressive procedures was planned and she was managed with active conservative management. Oxygen therapy and respiratory support with high flow nasal cannula and non-invasive ventilation were provided. Beyond regular care, a regular video call with the family was arranged for her. Several personalized collective measures were taken to keep the child motivated and involved like encouraging her to pursue her hobby to paint. She would paint cards for her family members every day. A combined effort by family, physicians and nursing staff could finally salvage the girl and discharge her home. We share this experience to highlight the need of timely management, shared discussion and team effort for successful outcome in severe disease. The delicate balance between shared responsibilities can be challenging and successful stories can evolve our understanding in striking the correct balance!