Chapter Twelve: Ethical Issues in End-of-Life Communication
Ethical Issues IN End-of-Life Communication
CRAIG M. KLUGMAN
Mrs. Johnson is in hospice with advanced kidney cancer. Mira, her daughter with a troubled past, is her primary caregiver. When Mrs. Johnson loses consciousness, Mira calls 9-1-1 and, ignoring her mother’s wishes, presses for all treatment possible. Mrs. Johnson is unconscious, uncomfortable, and in pain. The medical and nursing staff believe that interventions are causing discomfort with no hope for improvement. As Mrs. Johnson’s kidneys fail and pain medication loses effectiveness, Mira demands dialysis and experimental treatments.
Mrs. Chang has been admitted to the hospital with severe abdominal pain, bloating, fatigue, weight loss, and constipation. She is an immigrant and speaks limited English. A biopsy is sent to the lab for diagnosis, with advanced ovarian cancer being the most likely finding. Her eldest son has asked the medical team not to inform his mother if the result is cancer. He explains that in their society it is considered a cruel burden to inform someone that she has a terminal disease and that all information and decisions should come to him, not his mother.
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