You: “Ms.
Nielan, I want to talk to you about making plans for the future.”
(Pause and give the patient time to digest the information.)
“As you
know, you have metastatic ovarian cancer.”
“In thinking about decisions regarding resuscitation there is
a whole spectrum of choices. In event of an adverse situation,
some patients would like to be connected to life support and would
like us to do heroic life sustaining treatments. Others do not
want such measures.”
(Pause and give the patient time to digest the information.)
Ms. Nielan: “But I don’t want to die.”
You: Jane, I want you to live as long
as you want, but with good quality of life. I do not want you to
suffer and as your doctor, I will do everything in my power to
help you.”
(Pause and give the patient time to digest the information.)
Ms. Nielan: “Yes. I do not
want to suffer.”
(Pause and give the patient time to digest the information.)
You: “You have metastatic cancer. Down
the lane some time in the future, if your heart were to stop due
to the cancer, putting you on life support will not prolong life.
It would only prolong the dying process.”
(Pause and give the patient time to digest the information.)
Ms. Nielan: ……
(Pause and give the patient time to digest the information.)
You: “If things look good and
you have some temporary problem, then we could do everything possible
to get you out of the situation and back on your feet.”
(Pause and give the patient time to digest the information.)
Ms. Nielan: “That sounds good.”
You: “But if things look grim
and the cancer has advanced then at that point, any life support
measures would be ineffective.”
(Pause and give the patient time to digest the information).
Ms. Nielan: ……
You: “In a situation like
that, it is my opinion that we should hold back on futile resuscitative
measures, but really focus on making you comfortable.”
(Pause and give the patient time to digest the information).
Ms. Nielan:……
(If patient still seems reluctant)
You: “I want you to think more
about this and we can talk again next visit. I want you to remember
that no matter what, I will still be your doctor and here to help
you.” |
