Perspectives on Death and Dying

Goal

Develop a plan to help your patient and patient's family members deal with end of life issues.

Betty Billie is a 75-year old Seminole Indian woman living on the reservation near Naples. She has a history of non-insulin dependent diabetes and coronary artery disease. She speaks little English and was accompanied by her daughter when she was admitted into the hospital for congestive heart failure. She follows traditional Seminole Indian teachings and seeks guidance from native non-traditional health care providers and concepts in addition to traditional medicine. She takes both traditional medications and healer-prescribed herbs and other medicines. While in the hospital she has continued to worsen and develops more chest pain and dyspnea, possibly needing life support.

Betty's daughter, like her mother, is very traditional Seminole and wants to take her mother home to the reservation to see the healer and be with family. Betty's son arrives and indicates that he has an advanced directive. Betty is disoriented and therefore unable to clearly communicate her wishes to her family as well as her health care providers. There is confusion and anger as one family member argues with another over the care of the patient and the wishes of the patient.

You and your colleagues need to develop a plan and role-play of this scenario with emphasis on the script you might use given the situation.

Understanding of medical life-sustaining measures
Knowledge of advanced directives and health care surrogates
Understanding of various spiritual and emotional issues surrounding the end of life
Impact of family members on various decision-making scenarios

See evaluative rubric for additional grading criteria.