Question

A 68-year-old female has breathlessness, poor health status and multiple metastases. She is awake and anxious. Doctors believe aggressive chemotherapy, radiotherapy and ICU admission will not help, but her daughter insists on trying everything. How should the doctor handle this scenario?

• A. Convene to family members and consider the patient's needs
• B. Shift to ICU and start aggressive treatment
• C. Discharge the patient and shift to palliative care
• D. Give placebo care to relieve anxiety

Hint:

In end-of-life care, communicate clearly, consider patient autonomy and avoid futile aggressive treatment.

Answer 1

The Correct Option is A

Step 1: Understanding the Question:
This question explores the ethics of medical futility, end-of-life care, and communication strategies when there is a conflict between medical judgment and family wishes.
Step 2: Detailed Explanation:

Medical Futility: When a patient has advanced metastatic disease and poor performance status, aggressive treatments (chemo, ICU) are often "futile," meaning they cause harm/suffering without providing a meaningful benefit or extending life significantly.

Communication Strategy: The most appropriate first step in resolving this conflict is to hold a family meeting (convene). The goal is to explain the prognosis realistically, acknowledge the family's emotions, and align the treatment plan with the patient's actual needs and wishes.

Patient Autonomy: Since the patient is "awake," her own autonomy and preferences for care are paramount. The doctor should attempt to find out what "trying everything" means to the patient and the family.

Shared Decision Making: Rather than outright refusal or performing harmful acts (Option B), the doctor should transition the discussion toward palliative care—aggressive comfort management instead of aggressive curative attempts.
- Option B: Violates "Non-maleficence" as it performs harmful, futile acts.
- Option C: Is abandonment if done without a discussion and a plan.
- Option D: Placebos are unethical and deceptive in this context.

Step 3: Final Answer:
The next best clinical and ethical step is to hold a family meeting to discuss goals of care and focus on the patient's needs.