Mr. Alvarez is a 72-year-old Filipino male who was previously healthy with no chronic medical conditions, when he was suddenly admitted to the hospital subsequent to a stroke with left-sided weakness and dysphagia. Even though he spoke and understood minimal English prior to this admission, he has been having difficulty expressing himself and communicating with the nursing staff members, and easily gets frustrated whenever his requests and physical needs are not adequately met.
His hospital course was complicated by aspiration pneumonia and hypotension leading to end organ failure and sepsis, necessitating pressors, broad spectrum antibiotics and ventilatory support. While in the ICU, he coded, was resuscitated and eventually revived 15 minutes later, although this event left him with anoxic brain injury. Mr. Alvarez is a full code. He does not have any advanced directives in place, nor has he appointed his power of attorney for healthcare. He has not in the past expressed his wishes or communicated with his wife and children about his care preferences for this particular situation.
Due to the grim prognosis, the intensivist met and discussed with the family members the patient’s declining condition and poor quality of life while being kept alive on the ventilator, emphasizing that there was no chance of survival. The intensivist therefore recommended withdrawing life support.
The patient’s spouse, being the next of kin with the authority to decide on behalf of Mr. Alvarez, was very tearful and upset and was having difficulty processing the information given. She sought the advice of his children, and a family consensus was made to continue aggressive management. Their decision was based on several strong religious and cultural beliefs such as: “As long as there is faith there is hope”, “Miracles could happen”, “It is in the hands of God now”, and “God is the only one who can decide whether the patient will survive or not”.
As a healthcare provider, you feel strongly that this is an act of medical futility, and you are perplexed with the family’s decision to continue aggressive management in order to prolong the patient’s life despite his poor chance of survival.
Discussion Topics
1. As the healthcare provider, how will you be able to advocate for the patient and his family without undermining their cultural beliefs regarding end-of-life care?
2. Enumerate some strategies that can be implemented by the healthcare provider in order to achieve meaningful and culturally appropriate goals for the patient and family members.
