A Role Playing Exercise: Terminal Illness and A Disbelieving Family

The case is that of a elderly mother, in her 70’s, who was found several months ago to have cancer of the pancreas. Unfortunately, cancer of the pancreas especially in the portion called “the tail” has no symptoms or signs that it is present until it is large and spreading. This lady’s symptoms started first with mid-back pain but by the time the cause of the pain was diagnosed, the cancer had spread to other parts of her body. She had seen several cancer doctors and was recently hospitalized and had radiation therapy to the main cancer. Some doctor had told the patient and family, that after the radiation, surgery would be performed. However, when the surgeons examined the patient, they told the patient and family that there was no surgery that could be done. The family, consisting of two sons and a daughter, then tried to get other surgeons to evaluate their mother but none would accept consulting on the case because of an impression by the history that the patient was terminally ill. The family then arranged to have the patient under the care of another general physician and the patient was transferred to that physician’s local hospital. When this new physician reviewed the history and examined the patient, she realized that the patient was now dying from her cancer and probably wouldn’t live more than another week or two. The patient was now sleepy and confused because of her disease and pain medication and did not have the capacity to make her own decisions. The current physician told the family that the patient was dying and there was no further treatment for the cancer available and she should be given comfort care in a hospice environment until she died.

The entire family disagreed with the prognosis and pointed out that they were told that surgery was to be done after the radiation. They refused to believe that no further treatments for the cancer could be performed. They wanted “everything done” and insisted that cardio-pulmonary resuscitation be performed if their mother’s heart stopped. They insisted that the patient be transferred to a cancer medical center in the area. The doctor said she would request the transfer but was uncertain that the cancer hospital would accept the patient for cancer treatments.

Now, role-play that you are a hospital ethics committee member and the physician is coming to you for help with her situation. What would you advise the physician. What more can the current general physician do or say to the family? (By the way this is a real, true life event but the story has been altered enough to protect patient privacy.) ..Maurice.