Mrs. Thomas is a 54, year old African American widow, mother and grandmother, who lives with her daughter and four grandchildren (ages 12, 10, 7 and 5) in a 4 story walk up apartment. She is an active member of her church community and friends, comments that she had so much energy that she exhausted all of them just being around her. At age 51, she was diagnosed with non-Hodgkin’s lymphoma. Busy with raising her grandchildren, a little more than 3 years went by before she sought attention for her symptoms and was diagnosed. Despite aggressive treatments with chemotherapy and radiation, her diseased progressed and she was considering undergoing a bone marrow transplant. Climbing the stairs to the apartment one afternoon she became very short of breath and collapsed. Her twelve, year old granddaughter called 911. At the hospital she was minimally responsive and in severe respiratory distress. She was intubated and transferred to the ICU. A family meeting with the oncology and ICU team was called to discuss Mrs. Thomas’s advanced condition, the fact that she would probably not survive further treatment of the lymphoma and to decide on goals of care. Fifteen family members arrived, including her daughter, pre-teen granddaughters and grandson, three nieces, four nephews, several friends from her church and the minister. On being asked that only the immediate family participate in the meeting, the family and friends became angry and insisted that all of them be involved in this discussion.
Discussion questions:
1. What is your impression regarding this scenario? What are some concerns you have with this case and what do you anticipate would happen? Support your answer.
2. Have you thought about what kind of care you would want if you could no longer speak for yourself at the End of Life? Give examples.
3.How would you handle all the family members and friends wanting to be included in the discussion?
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