What are the cultural issues in D.M.’s case?

Medical Futility

Situation

D.M., a 65-yr-old Asian woman, has breast cancer with metastasis to

the liver and bone. The family asks you why their mother is not

receiving chemotherapy. They want to make sure that she will be

resuscitated should her heart stop. They are aware of her diagnosis

and that she only has a few months to live. In morning rounds, you

were told that D.M. does not want any more treatment that would

prolong her life.

Ethical/Legal Points for Consideration

• Although court decisions have varied, legally there is substantial

consensus about the right to privacy (a constitutional right), right

to informed consent and refusal of treatment, and rights about

end-of-life decision making. The Code of Ethics for Nurses

addresses the key components in the informed consent process

that nurses must address.

1

• A patient who is an adult and is competent (defined as capable of

understanding and interpreting information, making choices, and

communicating those choices) solely retains the right to make

personal health care decisions.

• The Patient Self-Determination Act requires that the patient be

asked on admission whether they have an advance directive. If

available, it is placed in the medical record. If the patient does not

have an advance directive, it must be documented.

• The National POLST Paradigm is an approach to end-of-life

planning that emphasizes patients’ wishes about the care they

receive. The POLST Paradigm is an approach to end-of-life

planning emphasizing the medical orders and includes coverage

regardless of location (e.g., hospital, home, assisted living).

2

• Often families have difficulty accepting the finality of a terminal

diagnosis.

• Sometimes family members have conflicting interests (e.g.,

finances, property, inheritance rights) that influence their

decision-making abilities.

Discussion Questions

1. How can you help D.M. communicate her wishes to her family?

2. How can you and the interprofessional team help the family in

planning end-of-life care that incorporates their mother’s

wishes?

3. What are the cultural issues in D.M.’s case?

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