Ethical Decision-making Using Trauma-Informed Principles: A Case Example

Irma Cannon (composite case and fictional name) is a 45-year-old patient (she/hers) who was admitted to the telemetry unit of an academic medical center 2 weeks ago after an unwitnessed syncopal episode. This is her third admission for complications of infective endocarditis within the past 7 months. Three days ago, she was transferred to the medical intensive care unit (MICU) in septic shock for which she received intravenous (IV) vasopressors and broad-spectrum antimicrobial medications. Blood cultures obtained at the time of her transfer to the MICU revealed new evidence of a systemic fungal infection for which IV micafungin was added to her care plan. Irma experienced symptoms reminiscent of opioid withdrawal upon administration of the first dose of micafungin and adamantly refused all subsequent doses of the medication. After repeated and urgent attempts to counsel Irma to accept micafungin for lifesaving reasons, the MICU care team consulted the hospital ethics...