There are several issues to recognize and understand in this challenging situation:
- Although intellectually, Mr. Martino’s wife may very well have expected this situation to arise and know exactly what her husband’s wishes were, intense emotions – anticipatory grief, fear, other emotions - may not reflect this intellectual understanding.
- The physician needs to explore these emotions and empathize. Consideration and inquiry about cultural or spiritual factors may also be important.
- The physician’s duty is to honor to the best of his/ her ability, the wishes of the patient, Mr. Martino, as clearly expressed, documented and understood by his wife.
- Support for Mr. Martino’s wife and daughter are available and should be requested; think about resources to assist and offer to contact:
- Family, friends, or other sources of personal support.
- Hospital chaplain or social worker.
- Special pediatric support services team (e.g. at Y.N.H.H., “Child Life”).
Examples of “what to say” or how to start a conversation in this difficult situation.
Recommended readings
- Fast Facts #184: Conflict Resolution: Principled Negotiation
- Hebert RS, Schulz R, Copeland V, Arnold RM. What questions do family caregivers want to discuss with health care providers in order to prepare for the death of a loved one? An ethnographic study of caregivers of patients at end of life. J of Palliative Medicine 2008; 11(3):476-483.