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22. A 77-year-old African-American woman is admitted to the hospital with severe shortness of breath. She lives in a nursing home. The patient has a history of dementia and left emiplegia. A chest x-ray shows a large pneumonia and several masses that are consistent with metastatic disease. The patient is a widow and does not have a designated health care proxy. You discuss the situation with her granddaughter, who used to live with her before the patient was transferred to the nursing home. She asks you to do everything that is in your hands to save her life. The rest of the family lives 2 hours from the hospital.Which of the following would be the most appropriate course of action in the care of this patient?
❏ A. Ignore the granddaughter's requests because any further medical care would be futile
❏ B. Ask the granddaughter to bring the rest of the family, and then discuss the condition and prognosis with them
❏ C. Follow the granddaughter's requests and proceed with mechanical ventilation if needed
❏ D. Obtain an ethics consult
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Key Concept/Objective: To understand cultural differences in approaching end-of-life issues
The ability to communicate well with both patient and family is paramount in palliative
care. Patients whose cultural background and language differ from those of the physician
present special challenges and rewards and need to be approached in a culturally sensitive
manner. People from other cultures may be less willing to discuss resuscitation status, less
likely to forgo life-sustaining treatment, and more reluctant to complete advance directives.
For example, because of their history of receiving inappropriate undertreatment,African-American patients and their families may continue to request aggressive care, even in terminal illness. Further interventions in this patient may not be indicated, and the physician may decide that doing more procedures on the patient would be unethical; however,it would be more appropriate to have a discussion with the family and to educate them about the condition and prognosis. Not uncommonly, the family will understand,
and a consensus decision to avoid further interventions can be obtained. If the medical
condition is irreversible and the family insists on continuing with aggressive therapies, the
physician may decide that further treatments would be inhumane; in such a circumstance,
the physician is not obligated to proceed with those interventions. An ethical consult may
also be helpful under these circumstances. (Answer: B”Ask the granddaughter to bring the rest
of the family, and then discuss the condition and prognosis with them)
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can u pl tell the role of ethics consult arises??
