In this chapter of Complex Ethics Consultations: Cases that Haunt Us, the author recounts a case from 1997 when the idea of "altruistic" organ donation was less accepted. The author provides insights into the deliberation during this period and the continued evolution and change of medical systems views of the control of bodies.

In this chapter of Complex Ethics Consultations: Cases that Haunt is, the author describes the request of a middle-aged patient with COPD for terminal ventilator withdrawal. The consult occurred soon after the author began working at a Catholic hospital. The patient’s husband objected to withdrawal, despite the fact that the patient had reasonable capacity and could mouth or write. The attending physician said he would not withdraw treatment if "there was disagreement" in the family. Upon questioning, the patient reiterated her wishes and said the team should not abide by his wishes and did not want him involved in the decision if he was objecting to her request. A week later, still on the ventilator, she declined SNF placement and her distraught husband wanted transfer. Suspicions about her husband gained traction on the unit. The author offers advice and insights for new ethics consultants. She was haunted by her inexperience, her doubt whether she was assertive enough, the narrative around her husband’s suitability as a surrogate, and some of the staff’s admonition that the consultant did sufficiently advocate for the patient.

In this chapter of Complex Ethics Consultations: Cases that Haunt Us, the authors discuss a circumstance of a request by a family to withdraw life-sustaining surgery only three days after open-heart surgery. The surgeon both wanted to respect family and to advocate for life for the patient. Although chances of recovery were slim, the surgeon struggled with the timing. The family had experienced a rocky postoperative course and were convinced that continuing was not what patient would want.

The series of cases discussed in Part III are humbling reminders of how intertwined our patients and their support systems are with healthcare practitioners. TJ, Jimmy, Mrs. Blue, and Mrs. Winthorpe all have unique experiences in different corners of the healthcare system. Each case touches on the familiar experience of a healthcare team identifying what they believe is in the best interest of patient, and there being a factor, often the patient themselves, complicating that coming to fruition. Their experiences, and different experiences of privilege and power, or disempowerment are salient elements of their stories. These “haunting” and morally distressing cases are revisited with an additional lens of diversity, equity, identity, and bias and considerations for how ethicists might more fully integrate these critical perspectives into ethics consultation.

In this chapter of Complex Ethics Consultations: Cases that Haunt Us, the authors describe a 24-year-old patient with C-3 spinal cord injury resulting in quadriplegia and ventilator dependence. He is admitted from a nursing home with multiple serious pressure ulcers. No family or friends who offered him support and companionship. With full decision-making capacity, he declined turning and dressing changes for up to a week. His ulcers were worse and a foul odor emitted from his hospital room. He wanted to live, not risk dying though his choices were doing just that. The ethics consultant negotiated a "Ulysses contract," stipulating that dressing changes and turning would occur once a day and his objections would not be honored. The patient agreed. The authors reflect on the ethical, professional, and haunting conundrum that arose due to this contract.

In this chapter of Complex Ethics Consultations: Cases that Haunt Us, the author describes a 14-year-old girl who presents with an ectopic pregnancy. She and her family are immigrants and although the girl speaks English, many of her family members do not. She fears her family would be disgraced if the news of her pregnancy is discovered and adamantly declines suggestions to enlist her mother. The author was asked about the permissible bounds to deceive the patient’s mother in order to protect the adolescent’s confidentiality. The patient might need help with the medication and clinical follow-up. The mother was told they were treating the patient’s pain, but she doubted the team’s veracity. The author reflects on balancing truth-telling, adolescent autonomy, and respecting cultural values.

This chapter of Complex Ethics Consultations: Cases that Haunt Us recounts the case of a previously healthy 7-year-old whom the author saw in the emergency department. In the PICU, she was diagnosed with meningococcemia and purpura fulminas. She required ventilation, dialysis, and vasopressors. If she did not recover, she faced double upper extremity amputation, multiple reconstructive surgeries, and uncertain neurological function. Her parents requested withdrawal of life-sustaining treatment, but PICU staff thought this was too soon and inappropriate. They wanted more time, which her parents declined. Her parents relied on a faith tradition that matched the author’s. He reflects on an ethics consultation in which he recommended respecting the parents’ wishes for terminal withdrawal. The author reflects on the child’s frightened face as he reassured her in the ED that she would be fine. She wasn’t. These thoughtful parents, who allowed another day for evaluation, asked what he would do if faced with the same situation and he replied. The child died.

This chapter of Complex Ethics Consultations: Cases that Haunt Us delineates how to use the book to educate ethics committees, ethics consultants, and bioethics students at all stages of study. Detailed educational activities are outlined for ready use by teachers, students, clinicians, and ethicists. The chapter identifies cases in the book with similar themes, proving invaluable case-based educational material.

This chapter of Complex Ethics Consultations: Cases that Haunt Us begins when the ethics consultant is asked if the mother (and suspect) in a case of shaken baby syndrome should be allowed to visit her child in the hospital. After two weeks, the baby remained ventilator dependent and the baby was likely to end up in a persistent vegetative state. Questions about whether the baby was suffering plagued everyone. Assuming parental roles and affections, nursing staff wanted to protect the baby and shift to comfort care. If this were authorized by the baby’s mother, she would face homicide charges. The baby’s mother visited as a prisoner, in chains. A prison guard compassionately unlocked the chains so she could touch her baby. The consultant is haunted by the sheer misery experienced by everyone, the persistent outrage from staff that her mom might serve as surrogate decision-maker, and the enduring sound of chains.

In this case of Complex Ethics Consultations: Cases that Haunt Us, the author recounts an ethics consultation involving a 70-year-old Roman Catholic nun in the cardiac ICU after emergency bypass and mitral valve replacement. As difficult postoperative complications began to resolve, including her respiratory function, the patient indicated that she wanted all treatments stopped, but in the past she had accepted treatments after initial reluctance. She pointed to her trach, saying she wanted it to be removed. Upon questioning by the ethics consultant, her discomfort was with the tube, not the ventilator per se. Reducing the diameter of the trach tube eased her comfort and she consented to a two-day trial. She was subsequently weaned from the vent. The author reflects on professional boundaries in ethics consultations and the risk that ethics consultants can inadvertently become stewards of the "culture of death" when they make premature assumptions.

In this chapter of Complex Ethics Consultations: Cases that Haunt Us, the authors describe a baby born at 25 weeks gestational age (at a time when survival at that stage was tenuous) to an adolescent mother. The fragile preemie developed necrotizing enterocolitis that was so extensive that definitive surgical resection was impossible. With no definitive treatment and inevitable suffering without it, the recommendation to shift to comfort care was declined and ethics consultants helped to negotiate the conflict.

In this chapter of Complex Ethics Consultations: Cases that Haunt Us, the author describes a 24-year-old woman who was comatose with a devastating neurological injury after suffering a cardiac arrest soon after receiving chemotherapy for acute myelogenous leukemia. The treating team recommended discontinuing ICU level care and shifting to comfort care. The patient’s mother declined, saying this course of action did not align with the patient’s and her Islamic faith and requesting transfer, which was impossible due to the patient’s medical instability. The author reflects on the culture of adult medicine, in contrast to her pediatric practice. She is haunted because she worries she did a good job as an ethics consultant but was lacking as a physician. This case raises the complexities of the dual role some consultants play as clinicians and ethics consultants.

In this chapter of Complex Ethics Consultations: Cases that Haunt Us, the authors discuss a case where a medical trainee did not provide best follow-up while working overtime hours at an unaffiliated medical urgent care clinic. The patient later came to the hospital at which the resident had a primary affiliation without the initial EKG. After the patient died, the ethics committee was confronted with a variety of issues including the scope of their responsibility as well as the gap in institutional responsibility.