Mr. B. is a 21-year-old African-American male who has been treated over the last year at your hospital for widely metastatic Burkitt’s lymphoma. Mr. B. had lived at home with his mother, but a few months ago against his mother’s wishes, he married his long time 17-year-old girlfriend who is the mother of his 2-year-old son. His mother does not get along with the patient’s wife. The couple have a small apartment and his wife has been trying to keep working nights as a nurses’ aide to support them. He’s applied for disability, but they currently have no consistent source of financial support except her part-time job.
Unfortunately, after his first course of chemotherapy, he became septic and nearly died in the ICU. His disease has continued to progress through second and third line treatment, and he has been hospitalized almost continuously for the last two months for dehydration and fevers, among other problems.
He has been evaluated for bone marrow transplant, but has steadfastly refused it because “I don’t want my family to lose everything because it’s probably not going to work at this point.” He has told you that he was pressured by his mother to have the evaluation: “It’s really hard to say ‘No’ to her. Mom told me she’d take the hospital to court, if they don’t do a full court press. She’s already contacted a lawyer. My wife can’t stand up to her, so I guess I’ll end up doing it even though I don’t want to.”
Questions:
What ethical principle(s) is/are at issue in this case?
Does this situation warrant an ethics consult from the hospital ethics committee? If so, who should initiate it?
What, if any, legal issues should be examined?
What patient/family issues should be addressed?
What advocacy role do you have as the oncology nurse taking care of this patient?
Full Answer Section
Ethics consult:
This situation warrants an ethics consult from the hospital ethics committee. Ideally, Mr. B. himself should initiate it, but given his mother's pressure, the oncology nurse or another member of the healthcare team could also request a consult to ensure his wishes are heard and respected.
Legal issues:
- Informed consent: Ensuring Mr. B. fully understands the risks and benefits of available treatment options, including the possibility of further financial hardship, is crucial.
- Patient autonomy and legal capacity: Evaluating if Mr. B.'s concerns about financial burden constitute a valid reason for refusing treatment and if he has the legal capacity to make his own healthcare decisions.
- Reporting elder abuse: Depending on the nature of his mother's pressure, it might be necessary to report potential elder abuse.
Patient/family issues:
- Addressing Mr. B.'s concerns about financial burden and exploring potential support resources.
- Facilitating communication and conflict resolution between Mr. B. and his mother.
- Providing emotional support and counseling for Mr. B. and his family.
- Ensuring the family understands Mr. B.'s right to refuse treatment.
Oncology nurse's advocacy role:
- Advocate for Mr. B.'s right to autonomy and ensure his informed consent for any treatment decisions.
- Act as a liaison between Mr. B., his family, and the healthcare team.
- Provide Mr. B. with information about financial support resources and legal options.
- Connect Mr. B. with social services or counseling resources to address emotional and practical needs.
Remember: This is a complex situation with no easy answers. The ethics committee, healthcare team, and legal professionals can provide guidance and support in navigating these ethical, legal, and patient/family issues. The ultimate goal is to respect Mr. B.'s wishes while ensuring he receives the best possible care and support.
Disclaimer: This information is for educational purposes only and should not be construed as medical or legal advice. Please consult with qualified professionals for specific guidance.