Case Study Summary
Mrs. Z, a 70-year-old woman who is unable to speak English, comes to the U.S. to have suspicious masses in her neck and axillary region evaluated. Biopsies of the masses revealed aggressive B-cell lymphoma. Her eldest son, who is her health care agent, asked the provider not to let his mother know that she had lymphoma. He believed that his mother would not be able to emotionally handle the diagnosis or tolerate the treatment, as his mother’s younger sister had died from lymphoma six years prior, despite being treated with aggressive chemotherapy. Mrs. Z’s providers argued that her lymphoma may not be similar to her sister’s case at all, considering lymphomas vary in prognoses and treatment. Mrs. Z’s oncologist and nurse practitioner (NP) believe that because her decision-making capacity is still intact, that she should be able to make her own decisions. They explained this concept to her son, and assured him that with the help of an interpreter, they could explain the patient’s diagnosis in a gentle manner, along with possible treatment options. However, her son did not agree to set up a follow-up appointment for his mother with the oncologist, and he also turned down the offer for the interpreter. The oncologist and the NP consult the ethics team to consider what should be done next (Scharf, 2021).
What is the Ethical Dilemma?
In this case study, the ethical dilemma is concerning autonomy vs. beneficence. Both parties, Mrs. Z’s son and Mrs. Z’s providers, believe that they are supporting the beneficence of the patient. The providers want to do so by allowing the patient to practice autonomy. They believe that because the patient’s capacity is still intact, that the patient should have a say over what happens regarding her own treatment. On the other hand, the patient’s son wants to protect her from grief and worry by withholding the information about her diagnosis from her. However, by keeping information about her diagnosis from the patient, the autonomy of the patient is breached.
Moral Argument
I agree with the oncologist and the NP; properly informing the patient of their diagnosis and allowing the patient to decide what kind of treatment they would like, is the best way to practice beneficence. Although Mrs. Z’s son wants what is best for his mother and feels that he is protecting her by not disclosing information about her diagnosis to her, he is actually causing more harm than good. Following the son’s wishes would go against the principle of beneficence. This is because, as the article says, lymphoma is different in every case. Each person responds differently to treatment (Scharf, 2021). Therefore, not disclosing her diagnosis to Mrs. Z could unnecessarily shorten her life. It is possible that she responds very well to treatment and is able to live many more years; it is also possible that she faces the same fate as her sister. The course of her life would only be known once the patient is able to practice her autonomy.
Additionally, the oncologist and the NP working on the case were correct in wanting a translator to explain the diagnosis to Mrs. Z, rather than the son. The patient’s autonomy may be compromised if a family member were to take on the role of the interpreter. A professional medical interpreter could serve as an unbiased party, who can gently explain the diagnosis to the patient and simultaneously put her at ease, thus concurrently resolving the worries the son had about delivering the news of the diagnosis to his mother. There is also less room for error if a professional is the one interpreting for the patient, rather than a family member. This way, the interpreter can give an accurate explanation for any questions the patient has and the patient can fully practice their autonomy (Scharf, 2021).
This case brings up a difficult situation where the patient is not able to speak for herself, due to her family “protecting her” and because she does not understand or speak English. Enforcing the patient’s right to autonomy by informing her of her diagnosis and utilizing an interpreter in doing so, will empower Mrs. Z to choose the path for her own life.
Works Cited
Scharf, A., Voigt, L., Vardhana, S., Matsoukas, K., Wall, L. M., Arevalo, M., & Diamond, L. C. (2021, February 1). What Should Clinicians Do When a Patient’s Autonomy Undermines Her Being Treated Equitably? Journal of Ethics | American Medical Association. https://journalofethics.ama-assn.org/article/what-should-clinicians-do-when-patients-autonomy-undermines-her-being-treated-equitably/2021-02.
