The death of a child: the use of group for conflict resolution.

Sam was a sevenyearold child, diagnosedinMay, 1987,ashavingterminal degenerativemuscleandnervewastingdisease.Previousto this diagnosis he had beena normal, healthy boy. However, when I met him, he couldno longersee,hearor move,and hadto be fed througha gastrostomy tubeinsertedfourmonthspreviouslyat theinsistenceof hisfather.Samseized frequentlyeventhoughreceivingboth Dilantin and Phenobarbital.He cried out when startled, otherwisehe appearedto be comfortable.He had troublehandlinghissecretions, thusrequiring frequentsunctioning.Thebest estimateof lengthof life for this child was2-10months. Samhadbeenathomein anearby town in the careof hisfather,George, andhisstep-mother, Sara,with thesupportof visitingnurses. Thefamilyconsistentlyrefusedanyhelpfrom hospice volunteersandall attemptsto getthem to acceptcounselingfailed. Whenahospicepatientis admitted to this hospital,heis admittedto the palliativecareunit. The hospicestaff andvolunteersbecomeanintegralpart of thepalliativecareteam.Childrenare admittedto the pediatricunit and the teamgoesto them. Sam had beenadmitted to the pediatric unit because,in their exhaustion and emotional pain,