Ethical dilemma: 55 year old female african american and in the Muslim culture, in hospital complaints of chronic pain and frequent, urgent urination for at least 3 months now. Urine tests showed trace blood(hematuria), physician told the patient she should see a urologist for follow-up. The patient said she would call for an appointment herself. Weeks later she came in for pain again this time with her son. Physician discussed if followup with urology occurred the patient refused because she did not want to undergo a pelvic or vaginal exam and would rather try herbal medicine. The patient’s son attempted to persuade her to undergo more evaluation. There was no question of her legal and mental competency, she understands the importance of a complete diagnosis and proper treatment.

The physician discussed the matter further with the patient, encouraging her to see a urologist, advising her of the risks of serious kidney or bladder diseases and emphasizing the importance of getting further assessment of the hematuria. The patient still refused to seek further work-up and will try holistic medicine. After much convincing a few months later by her family, due to symptoms of pain and gross hematuria. and herbal medicine not alleviating her symptoms she finally agreed to see a urologist, and she was subsequently diagnosed with renal cell carcinoma which reached Stage IV and metastasized to her brain and lung.

autonomy and beneficence ?

1. What information is important for you as the social worker on the Palliative Care Team to
obtain and present to the Ethics Committee in order to help resolve the ethical dilemma?

2. What, if any, laws or regulations exist related to this specific ethical dilemma?

3. Discuss the arguments put forth on both sides of the ethical dilemma and use 4 references to support each position. What is the diagnosis and prognosis? Clarity re prognosis

Symptom burden?

Medical/illness history- clear understanding of risks and benefits of treatment?

Psychological & emotional considerations, inc. cognitive status, mental illness hx?

Family systems- role and relevant caregiver information?

Socioeconomic factors?

4. Which cultural groups have the most difficulty with the ethical issue? Why?

Cultural/religious factors/ Consideration of how social location informs ethical decision making: gender, age, culture, faith practices, etc