This interchange place the physician in a considerable quandary. On one hand, he was inclined to respect the wishes of the mother to continue treatment and avoid involvement of the patient in the decision making. The mother had, after all, assumed decision making responsibilities throughout her daughter’s illness. Moreover, even if the mother’s desire the continue aggressive treatment was ill advised, he recognized that her well being and the well being of her husband would continued to be affected even after their daughter’s death by decisions made at this crucial time. Possibly they needed further assurance might lead to considerable her competent to participate in the decision making. She had been involved in discussions of therapy and had been particularly interested in developments during the early phage of her treatment. He was confident of her ability to comprehend the information relevant to the decision, and he knew( from the nurse’s report) that the patient understood that she might soon die. He did, however, have reservations about her emotional to defer to her mother’s wishes throughout her treatment. At the same time, securing some understanding of the patient’s feelings might help determine whether continued aggressive therapy was enhancing her well being or intensifying her suffering.The physician had several options(1). Accept as final the mother’s decisions to continue aggressive treatment and to not involve the daughter.(2). Tentatively accept the mother’s decision, but spend the next several days ( should the patient survive) attempting to change her mind on both counts possibly by helping her to accept her daughter’s impending death(3). Accept her mother wishes not to involve the child in the decision making, but taper off various supportive measures( such as blood transfusions) to hasten the child’s death and relieve her of further suffering. Reduction of aggressive efforts would be accomplished with out the mother’s knowledge(4). Interview the patient without her mother’s knowledge. Sensitively ask her to clarity her feelings about continuing aggressive support measures, this approach would necessitate open acknowledgement and discussion of the likelihood that she would soon die(5). Interview the patient without her mother’s knowledge. However, make an attempt to “feel out” the patient about her desire to discuss the situation
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