Mr. B.: Family Conflicts
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?