Current Events April/May

http://www.nytimes.com/2012/04/13/health/states-seek-to-curb-exorbitant-drug-costs-incurred-by-patients.html?_r=1&nl=todaysheadlines&emc=edit_th_20120413

Diving Bell & the Butterfly

What other observations or questions do you have about the film?

Case 10 Cultural Differences

Case 10: Pain Relief, Cultural Beliefs, and the Role of a Family Member

Josh, Megan, and Eric

This case considers challenges that occur when an individual’s request for medical treatment conflicts with her religious beliefs. Marie F. is suffering from terminal lung cancer, and requested pain medication, which made her delirious. She and her brother, Jean, are Haitian immigrants, and her brother believes that her incoherence is due to evil spirits brought on by the pain medication. He demands that the pain treatments be stopped.

Facts to consider:

·         Marie was coherent when she originally requested pain medication

·         Religious beliefs dictate that evil spirits be exorcised; if Marie were aware of her current behavior, she might agree with her brother’s demands

·         Their cultural beliefs may state that male family members make decisions on behalf of females

Options:

·         The nurse could continue treating Marie’s pain against Jean’s wishes

·         The nurse could discontinue Marie’s treatment

·         The nurse could come up with an alternative (and possibly less-effective) method of pain relief that might have less extreme side effects

Questions:

1.      Whose requests should the nurse follow?

2.      Would your response to Question 1 be different if Marie had named Jean as the person responsible for her medical care and end-of-life decisions, i.e. power of attorney?

3.      If Jean did legally have power of attorney status, should he be able to base his decisions about his sister’s care on religious beliefs, rather than medical science? How much of a role should religion have in influencing medical treatment?

4.      If the nurse chooses to obey Marie’s initial request, how could she go about explaining her decision to Jean? Would educating him on the known side effects of pain medication make a difference?