N.L., a 56-year-old female with no close relatives, is a patient at St. Agatha's Hospital. She has no medical insurance. She has ovarian cancer that has spread to other parts of her body. She has a guarded prognosis and has been told she has, at most, one to two months to live. She is experiencing a good deal of pain and discomfort despite her physician's efforts at pain management, and this is expected to get worse.
A common side effect of ovarian cancer is the development of blood clots in the legs. N.L. is now experiencing a pulmonary embolism. The embolism will soon be fatal if not repaired. N.L. is conscious and competent to make treatment decisions. The physician in charge of her case has spoken with the surgeon, who says that surgery to remove the clot is possible. The surgeon and N.L.'s physician agree, however, that such surgery would not be a good choice in this case. The patient's cancer has already spread to many other parts of the patient's body, so the surgery, at best, would only extend N.L.'s life by a month or so. Furthermore, N.L. would be facing a poor quality of life during that time from the advancement of the cancer, in addition to recovery from major surgery.
N.L.'s physician is also very aware that the proposed surgery is much more expensive than the palliative care he thinks is best for the patient, and that there are limited charity care funds and that a good number of other patients could better benefit from these funds. Instead of presenting the options to the patient without recommending any option, N.L.'s physician is considering recommending only palliative care to N.L., and attempting to dissuade her from requesting the surgery option. (Source: Unknown)