Case analysis: “The Case of Mrs. W.”

The Case of Mrs. W.

Mrs. W., 72 years old, has been treated for metastatic cancer of the uterus. The prognosis for this

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type of advanced cancer is grim, with a less than 20% likelihood of survival at the end of 6 months.

Her physician recently obtained permission to use an experimental protocol for patients with this diagnosis who had not responded to conventional therapy. She informed Mrs. W. about the drug trial

in the presence of one of the oncology nurses, who was asked to witness Mrs. W.’s signature on

the consent form. The nurse agreed to serve as a witness. After they were finished discussing the

study, the nurse asked the physician to leave the consent form so that she might review it for her

own information. On review, the nurse thought that the study was represented to the patient in

terms that were too optimistic and that the patient was led to believe that there was a good possibility

of cure or at least an extended life span. The form was accurate in its discussion of the scientific

merit of the research and the fact that there may not be any benefit, but the nurse believed that the

physician’s description did not coincide with the physician said, “Look, it’s all she’s got. Neither you nor I know if this will be helpful, but if she starts out thinking that it won’t be, it will compromise the

potential for the therapy to work at all. 1 think that I gave her a fair description of the drug and its toxicity. Besides, she can read it herself and get the full range of potential side effects of the drug. She

needs for me to be hopeful. She’s from the old school and really wants her physician to make decisions

for her that are in her best interest; she’s told me as much. We also need to know whether

this has any hope of being a beneficial treatment for future patients.”

Questions:

What should the nurse do now? She has witnessed only that the patient actually signed the

consent form, not that the consent was fully informed.

Does she have any further obligation to the patient? Will further discussion with the patient

do more harm than good? Should the patient receive a more candid explanation, or should she

just be expected to read the consent form for further information if she desires it.