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

1. 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 (Links to an external site.) (Links to an external site.)
2. 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.
3. 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.
4. 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(Links to an external site.) (Links to an external site.)
5. Often families have difficulty accepting the finality of a terminal diagnosis.
6. Sometimes family members have conflicting interests (e.g., finances, property, inheritance rights) that influence their decision-making abilities.

Discussion Questions

• How can you help D.M. communicate her wishes to her family?
• How can you and the interprofessional team help the family in planning end-of-life care that incorporates their mother’s wishes?
• What are the cultural issues in D.M.’s case?