Bioethics Mediation: A Guide to Shaping Shared Solutions, Revised and Expanded Edition

15. Don't Tell Mama: A Role-Play

203 15 Don’t Tell Mama: A Role-Play General Instructions All players should read the general instructions. Before beginning, teachers should review “Using the Role-Plays” in the introduction to Part V. Parties Dr. Simon, chief resident Dr. Miller, attending physician B. Wong, head nurse Jeffrey Gold, patient’s son Eleanor Katz, patient’s daughter Bioethics mediator Dr. Lowe, intern (Omit if there are too few people to cover all the roles.) Background “I didn’t know what to do,” said Dr. Lowe, the intern. “I was about to go into Mrs. Gold’s room to get consent for the colonoscopy when suddenly they were all there in my face saying, ‘Don’t tell Mama if she has cancer. Tell her anything else, but not that, not even that it’s a possibility. It would kill her.’” The “they” Dr. Lowe referred to were the grown children—a son and a daughter —of the patient who had been admitted two days ago. Mrs. Gold is an eightytwo -year-old widow who was brought to the hospital by her daughter after several weeks of fatigue, weakness, and gastrointestinal disturbance. Her history and physical strongly suggested colon cancer, and a colonoscopy would be helpful in establishing the diagnosis and developing a treatment plan. “I was so startled, I just kind of nodded at them and mumbled something about not having anything definite to tell anyone yet,” Dr. Lowe continued. “We all trooped into Mrs. Gold’s room, and they stood there while I explained that we needed her consent to do some tests to see why she is not feeling well. I don’t know if I sounded as evasive as I felt. When I told my resident what had happened, she was furious. She said that patients have the legal right to know their medical information and the family has no business telling us not to disclose it. When we made rounds the next morning, the family was waiting outside the patient’s room and warned the team again. My resident explained about the patient’s right to informa- 204 Bioethics Mediation: A Guide to Shaping Shared Solutions tion, and the son said: ‘Listen, I’m a lawyer and I know all about rights. If you say anything that upsets or harms my mother, you’ll find out firsthand what the law has to say.’ Before things got even more tense, however, the attending, Dr. Miller, stepped in and assured the family that we would not do anything to put the patient at risk.” Mrs. Gold’s tests have revealed that she does indeed have colon cancer. Dr. Miller put a big note on the front of the chart: “Patient is not to know her diagnosis as per instructions of family.” There is considerable difference of opinion on the team about the appropriate way to handle the situation during the time Mrs. Gold is hospitalized for surgery and subsequent treatment. The effort to avoid talking with Mrs. Gold about her condition has been very awkward for the house and nursing staff. Several staff feel that they are being dishonest and, as a consequence, not spending as much time with her as she deserves. Others feel intimidated by the threat of a lawsuit if they disregard the family’s instructions. At the suggestion of Brenda Wong, the head nurse, Dr. Lowe has requested an ethics consult to clarify the issues and provide guidance in dealing with this uncomfortable situation. Don’t Tell Mama: A Role-Play 205 Don’t Tell Mama: Clinical Ethics Simulation Confidential instructions for DR. LOWE, intern (Please do not show these instructions to the other participants.) You are the intern taking care of Mrs. Gold, and you are thoroughly confused. On the one hand, you agree with your resident that patients should be told about their conditions. Not only are they entitled to the information, but also it was so awkward being evasive with Mrs. Gold. Even though you didn’t exactly lie to her, there was a sense of conspiracy, as though you and her children were working together to keep her in the dark. And now they will expect you to continue withholding the information, even if she asks you directly. It would be so much easier just to be open with your patient. On the other hand, Mrs. Gold’s children have known her a lot longer and know her much better...