In this case study, a 70 year old Pakistani widow, Mrs. Z, came to the United States to live with her children and receive an evaluation of her neck and underarms due to the presence of suspicious masses. After a physical exam and biopsies were performed, it was diagnosed as an aggressive B-cell lymphoma. Mrs. Z also has a family history of lymphoma, as her own sister had passed away from this six years prior, despite aggressive treatment. Mrs. Z appointed her son to be her health care agent. After the diagnosis, he falsely told her that the masses were not cancer. He requested that his mother should not be told that she has B-cell lymphoma, as he believed that she was not emotionally strong enough to cope with her diagnosis, or physically strong enough to receive treatment. Mrs. Z’s physicians informed Mrs. Z’s children that every case varies, and that they would tailor a treatment plan according to her individualized needs. Furthermore, they wanted to discuss all of the risks and benefits of receiving therapy, given Mrs. Z’s age and any comorbidities. They communicated that they can use an interpreter to compassionately explain all of the steps to Mrs. Z, because she was deemed capable of decision making. However, the children declined any follow up appointments with an oncologist and the use of an interpreter.

The ethical dilemma is between patient autonomy and nonmaleficence. Nonmaleficence is the principle that encourages providers to do no harm. Patient autonomy is the principle that encourages providers to respect a patient’s decision making capability for themselves. In this case, the providers wish to convey the full truth to Mrs. Z, and allow her to make her own informed decisions with the use of an interpreter. However, Mrs. Z’s son wants to do no harm to his mother, as he emphasized that the diagnosis would place her in emotional distress and she is not strong enough to cope with the reality of her situation. The providers also do not wish to do any harm to Mrs. Z, but withholding the truth from her would impede her ability to practice autonomy. 

In practice, it is vital to uphold the core values of PA practice: autonomy, beneficence, nonmaleficence, and confidentiality. Beneficence is the principle that encourages providers to do good for others. I agree with the providers because the physicians are trying to use adequate resources, such as an interpreter, to ensure that Mrs. Z fully comprehends her diagnosis and all possible treatment plans. They are practicing beneficence because they respect Mrs. Z and her right to know what is going on with her own health. She was deemed to have full decision making capability, so Mrs. Z’s son is only supposed to make decisions for her if she is deemed incapable to do so. Therefore, using an interpreter and allowing her to choose a treatment plan is only allowing her to practice autonomy. By abiding by his wishes, Mrs. Z’s son is preventing the providers from practicing beneficence because he is forcing them to withhold vital information from her, which then causes a breach of the core value of patient autonomy as well. Providers understand that family members want the best for their loved ones. However, withholding information about her diagnosis and treatment plan causes more harm than good, which violates the core value of nonmaleficence. Although every diagnosis can cause an emotional toll on a patient, it is more harmful to be unaware of the severity of one’s diagnosis. Particularly in Mrs. Z’s case, not undergoing the proper treatment could possibly result in her shortening her life by many years. This would negatively impact her quality of life or her ability to return to a normal life. Lastly, using Mrs. Z’s family as an interpreting service may violate the principle of confidentiality. Although her son was appointed as her health care agent, we are unsure whether he would accurately translate the information being provided. Using a professional medical interpreter could eliminate all possible bias or withholding of the truth. This would ensure that she could practice patient autonomy to the fullest. 

Despite being unable to speak or understand English, there are various services that allow individuals with limited English proficiency to make medical decisions for themselves. This involves the standard that providers are upholding the values of PA practice, and that interpreting services are being utilized. In this case, Mrs. Z’s children want to protect her from the emotional baggage of knowing her cancer diagnosis, but they are limiting the ability of the providers to uphold the core values of practice. In turn, this negatively impacts Mrs. Z’s ability to practice patient autonomy and seek appropriate treatment for her condition. 

References

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.

This entry is licensed under a Creative Commons CC0 1.0 Universal Public Domain Dedication license.