A 54-year-old male patient has been treated for cancer for 2 years, but his illness has not responded to the major lines of treatment. He has been admitted to hospital with worsening nausea and vomiting, abdominal pain, and failure to thrive.
A CT scan showed progression of disease as evidenced by new ascites along with peritoneal and bone metastasis. He remains on dialysis, but otherwise the treatment plan is symptom management.
His physicians have held several conversations with the patient and his family (wife and children) regarding his “code status.” The patient and his wife want him to be a “full code,” but the physicians feel it is not in his best interests given his terminal illness; they feel it will actually be harmful to him. ICU physicians were consulted and agree.
The patient and his family are Muslim and believe that everything needs to be done to prolong his life, otherwise they will “displease their God”. The patient’s wife is under considerable pressure from her husband’s brother to ensure everything is done to save him.
The patient is currently a full code and “stably ill”, but the physicians and nurses are worried about what will happen in the event he suffers a cardiac and/or respiratory arrest.
- What are the competing values in this case?
- How might you respond to this request?
- What additional information could be shared between the patient/family and health care team to help resolve this issue?
- What role does the patient’s faith play in this case?
Some Values and Ethics Issues to Consider
- Respect for autonomy
- Patient-family relationships
- Spirituality and religious beliefs
- Substitute decision-makers
- Respect for professional integrity
- Pluralism and diversity
- Beneficence and non-maleficence
- End of life decision-making