End-of-Life Issues:
Case 1 Discussion
For metastatic nonsmall cell lung cancer, palliative chemotherapy
is an intervention providing, on average, a small benefit at considerable
toxicity (a consideration for the Medical Indications box in a Clinical
Ethics 4-box analysis). Yet for a patient who is well informed, understands
the benefits and burdens, and wishes to proceed, a trial of palliative chemotherapy
is justified. However, now Skip is voicing concern: the most important thing
to do is hear him out. Find out what he is worried about, how he rates his
quality of life, and what his goals are. This information will help you
sort out what is going through his mind and help you guide him to a decision
that will be the best for him.
As Skip thinks through his situation, ask him if he wants you to describe what would happen if he decides to have more chemotherapy, or stops his chemo and starts hospice care. Eventually you might ask him what a good death would be for him--he may not be able to answer immediately, but it might help him (and you) shape a care plan later. When you talk with Skip, keep in mind the goals for a decent death.
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