Chronic Obstructive Pulmonary Disease (COPD): Part 2

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Ms. Jones didn’t know what to do, and decided to discuss this with the admitting physician and her nursing supervisor, and also considered the possibility of discussing it with the chair of the hospital ethics committee. She had heard the patient refuse, and yet the family clearly wanted everything done, and they had good reasons to make her doubt the decision she had heard Mr. Moua make.

When his Hmong family physician Dr. Michael Khang arrived, she asked him. He replied that Mr. Moua had always been afraid of hospitals with particular fears that the hospital doctors and nurses would do things to him that he didn’t want. So, while he had needed hospital care these past 3-4 days, he had refused it out of fear. Dr. Khang said that he would speak to him in White Hmong and try to resolve this uncertainty about DNI.

Ms. Jones accompanied Dr. Khang into the room. She watched as Dr. Khang pulled up a chair and sat next to Mr. Moua, and talked with him in low seemingly caring tones. She noticed that Dr. Khang didn’t stare at Mr. Moua during their conversation, but rather looked away from him, and then periodically looked at him directly. Also, Dr. Khang talked with the son, who then talked to his father.

When finished, Dr. Kang explained to her several things:

  1. Mr. Moua was a shaman and was confident he would recover, as his shaman helping spirits had told him that he wouldn’t die from respiratory problems. So, he didn’t think he would need the ventilator.
  2. However, he wasn’t ready to die, and so after much discussion back and forth, including with his son, Mr. Moua seemed to relent, saying that if the machine would help him live, he would accept it, however, he didn’t think he would need it, so didn’t think the discussion was necessary.
  3. Mr. Moua’s son was instrumental in helping his father decide to accept intubation and ventilation. Dr. Khang felt that Mr. Moua listened to his eldest son more than Mr. Moua listened to him. Perhaps Mr. Moua wanted to please his son, but he seemed to respect his son’s opinion and seemed to be more reassured by his son’s opinion about intubation/ ventilation than about Dr. Khang’s opinion.
  4. However, Dr. Khang felt Mr. Moua’s fears and concerns were not completely addressed, and knew that Mr. Moua was afraid that the doctors and nurses would take advantage of him, and harm him, rather than help him with the ventilator.
Questions for Discussion

Questions for Discussion
1. What do you think Dr. Khang did that helped facilitate this discussion? What knowledge and skills did he possess that Ms. Jones didn’t have?

2. What role do you think Mr. Moua’s eldest son had? Do you think that Mr. Moua’s final decision was an independent decision, or was he overly swayed by his son?

3. What would you have done if Mr. Moua and his son had different opinions?

4. What do you think about Mr. Moua’s apparent agreement when he still seems to disagree? And why is his fear of the hospital harming him seem to be paramount?

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