Some people believe that knowing negating information about one's health will only make them more ill. In some instances this is the reason why patients do not want to know their prognosis. Not having information about ones prognosis can also hinder people from getting the proper medical attention, which can be a major problem and reduce life expectancy.
In both case the family member had reservations about truth telling because they feared that doing so would be harmful to the patient. The physicians on the other hand had a duty to tell the patients the truth because doing so is of benefit to the patients. In some cases this beneficence that doctors have a duty to honor is in conflict with what family members might view as being beneficial to the patient. In some ways what the family members feel in terms of disclosure should be taken into consideration. After all the family of a patient knows the patient better than the doctor and as such the family knows how the patient will react to information and how a negative prognosis might affect them.
In cases where there is confusion concerning what is maleficent and what is beneficent both doctors and families have to make difficult choices. On the one hand the doctor has the duty to do no harm to the patient. Therefore if telling the patient that the prognosis is poor is going to do harm to them emotionally to the point that they may lose their will to live all together, perhaps not offering them all of the information may not be the wisest choice. On the other hand families also have to recognize that terminally ill patients often need to discuss their illnesses and prepare themselves for facing end of life decisions. When these facie principles conflict with each other the best plan of action would be for the doctors and the families to have a meeting to flush out a compromise that will allow the doctor to interact with the patient in a way that is beneficial while also conforming to the wishes and desires of both the patient and the family. This type of compromise will assist in ensuring that everyone involved will be able to deal with the outcome.
The cultural and ethnic differences are not necessarily the reason for why the female patient does not want to know her prognosis. In addition "The complexity of the truth-telling task is more acute in end-of-life decision making, when decisions must be made in a timely manner, under highly emotional circumstances, without the benefit of retrospection (Turner, 2003)." There are many people who are not from that region of the world who might take the same stance. Even if it were a cultural or ethnic issue, the people involved are living in American and there are certain disclosures that are mandated under American law as it pertains to the patient/doctor relationship.
Facts: The patient is Sherry, she is 38 years old. She was diagnosed with Leukemia. She was a bone marrow recipient but it was a mismatched unrelated donor, which can cause graft vs. host disease (GVHD) of the gut. This has a negative impact on the absorption of nutrition and causes severe diarrhea. Her organs are failing and it is likely that she will die soon. Opinions: Sherry will likely not survive much longer, it is better for her to know the truth about her condition, she will be a burden to her mother if she returns home.
The features of this case that are good include the patient's willingness to take the advice of doctors although there was some apprehension at times. The fact that the patient is alive and still fighting to live are also good aspects of the care. The patient seemed to have a strong will and fight through her health issues as much as she could. Even when doctors did not think her condition would improve she had bouts of improvement. At the end of the case it was also good that the patient understood what hospice care meant and that she could go home if she so desired. For this particular patient it was essential that she understood that hospice did not mean that she had to give up her fight.
The bad features of the case include the patient not wanting to face the possibility that she could die and make the needed end of life decisions. She did, however give her mother power of attorney. Sherry's son also seemed to be in denial and having a hard time accepting his mother's illness which complicated matters. In addition doctors were slow to tell her how sick she was. They did not tell her for some time that she would probably never eat again. All of these issues affected her care and her attitude towards the care.
As it relates to outcomes, Sherry did put into place a Do not resuscitate which means that if here organs continue to shut down, she will likely be in distress and die. Sherry's mother has been put in the position that she will have to carry some amount of burden when Sherry goes back home. However, the mother seems to understand the difficulty and is willing to have Sherry at home.
As it pertains to Sherry's case it is obvious that she is a young woman who really has the desire to continue to live. However her condition is severe and her organs are failing. Doctors and the other healthcare professional tending to her treatment understand how sick she is and while there is always hope, the chances that she will survive are limited. In this instance it seems reasonable for Sherry to go home and have a hospice provider. In doing this she can be in a more comfortable environment and although she might die at least she will be surrounded by things that are familiar to her. On the other hand being at home may also assist her in getting well again and getting off of hospice. Although it may be difficult for her mother, having the hospice care will also take some of the burden off of Sherry's mother. The doctors have done all they can to assist Sherry and to save her life, however further treatment will likely not benefit her at this point. As such the most reasonable step to take is to return home with the assistance of hospice care.
In the case of a patient who is not able to make his/her own decisions it is important that a chaplain or anyone else be respectful of the surrogate. In most cases when there is a surrogate that person was chosen by the patient. As such the patient trusted their judgment and trusted them. Perhaps the chaplain might be able to talk to the surrogate in a manner that is not intimidating and fully explain the gravity of the situation. It is not clear how much information that the Chaplain knows or understands about the condition of the patient but if the surrogate is not taking the advice of physicians based on religious beliefs it may be difficult for the chaplain to change the mind of the surrogate.
The chaplain will need to collaborate with the medical team and the surrogate to see of there is some type of compromise that can occur as it pertains to the patient's care and how to treat the patient in a way that is dignified and does not prolong suffering. For instance the chaplain can meet with the medical team and the surrogate individually and determine what a compromise might be composed of. Both the doctor and the surrogate must agree that whatever decision is made is in the best interest of the patient. For instance the patient is likely in a great deal of pain, there must be a concerted effort to ensure the patient is comfortable. If the patient is still taking chemotherapy or radiation it is important to explain and assist the surrogate in understanding the situation that the patient is in as it pertains to continued treatment. Failure to take these steps can lead to making decisions that are hasty and may not be in the best interests of the patient. In this situation the chaplain can serve as a neutral party who desires to ensure that the problem is resolved.
While it would be acceptable for the chaplain to speak to both parties involved and serve as a neutral voice, it would be unethical for the chaplain to be disrespectful toward the surrogate or to be condescending toward the beliefs of the surrogate. It is important that Chaplin be aware of his/her boundaries and handles the situation with the utmost care and compassion. In this instance the chaplain has to possess the right type of temperament and handle the situation accordingly. Failure to do so might lead to a situation…