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.
• 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).
• Often families have difficulty accepting the finality of a terminal
• Sometimes family members have conflicting interests (e.g.,
finances, property, inheritance rights) that influence their
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
3. What are the cultural issues in D.M.’s case?
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