Problem
Addressing a Patient's Experience of Transgenerational Trauma
A retired veteran, Mr. S, enlisted in the US Army with hopes of giving his family a better life. He is an active Black elderly man with no significant illnesses or injuries before being brought to an emergency department (ED) after collapsing at home. Clinicians learn that, for about 3 months, Mr. S has experienced early satiety (feeling full after consuming only a few bites of food), weight loss, and persistent fatigue. Following hospital admission, an endoscopic biopsy reveals localized gastric adenocarcinoma, and a surgical team, led by Dr. D, evaluates Mr. S for gastric resection.
Mr. S's wife, children, and several grandchildren are present with him in the hospital. Dr. D explains gastric resection to Mr. S and his family, and Mr. S clarifies that he does not want surgery because he is "unsure whether I would make it." Dr. D asks him to say more about not wanting surgery.
Mr. S explains that, when he was young, his father had an operation for an infected foot ulcer. His father was discharged home the morning after his operation with minimal instruction on how to care for the wound and without any home resources to facilitate ongoing wound care.
Despite the operation, the foot infection did not get better. Instead, the infection got much worse. His father's leg became rapidly necrotic after discharge home. The involved skin, fat, and muscles of his foot began to die as the infection spread rapidly up his father's leg. His father sought care from multiple surgeons, and no one agreed to care for him. Mr. S remembers waiting for hours and hours in numerous emergency rooms with his father as they sought treatment.
He remembers his father being accused by one nurse in an examination room of "not taking care of himself."
Unfortunately, by the time his father was appropriately evaluated and able to be admitted to a hospital, the infection had spread all the way up to his thigh and hip. He was admitted to an intensive care unit and died the following day.
Mr. S explains that he worries this could happen to him, although times have changed. "Some things haven't changed. It's nothing personal against you, Doc. I just don't want this surgery." Dr. D wonders how to respond.
Answer the following questions in essay
• How should Dr. D respond? Should he try to convince Mr. S to get the surgery? Should he try to convince the family to change Mr. S's mind? Should he respect Mr. S's decision? Which moral principles might be at play here? Explain your reasoning.