Lucia Velendez is a 45 year old single mother who has been living with breast cancer for several years. Her cancer has been treated with limited success as part of a research protocol that she volunteered for 6 months ago after an unsuccessful chemotherapy treatment. Her physician has expressed to her his clinical opinion that there is no other options available to her and is encouraging palliative care now. Lucia is adamant that she continue fighting so that she can attend her oldest son’s graduation from college the following year. He will be the first in their family to have attended and graduated from a university.

She has requested to be have TPN (total parenteral nutrition) line inserted into her so that she can receive uninterrupted nutrition. She has had difficulty feeding in recent weeks. She wants to go through another treatment cycle in the research protocol. The TPN will allow her nutrition and greater energy, but the research treatment is very difficult and while it may help her – the side effects are dangerous and she could possible die sooner than going without treatment.

Discussion Questions?

1. Should Lucia’s wishes be adhered to despite her physician’s recommendation?
2. How would you feel if you were the physician treating Ms. Velendez?
3. Are there other alternatives to be considered? If so, which?
4. How might the physician best approach this topic with Ms. Velendez and her family?
5. Should her family be involved in the decision making process?