You are a staff nurse on a medical unit. One of your patients, Mr. Dau, is a 56-year-old Hmong immi- grant to the United States. He has lived in the United States for 4 years and became a citizen 2 years ago. His English is marginal, although he understands more than he can verbalize. He was admitted to the hospital with sepsis resulting from urinary tract infection. His condition is now stable.

Today, Mr. Dau’s physician informed him that his computed tomography (CT) scan shows a large tumor in his prostrate that is likely cancer. The physician wants to do immediate follow-up testing and surgical resection of the tumor to relieve his symptoms of hesitancy and urinary retention. Although the tumor is probably cancerous, the physician believes that it will respond well to traditional oncol- ogy treatments. The expectation is that Mr. Dau should recover fully.

One hour later, when you go in to check on Mr. Dau, you find him sitting on his bed with his suitcase packed, waiting for a ride home. He informs you that he is checking out of the hospital. He states that he believes he can make himself better at home with herbs and through prayers by the Hmong “faith healer.” He concludes by telling you, “if I am meant to die, there is little anyone can do.” When you reaffirm the hopeful prognosis reported by his physician that morning, Mr. Dau says “The doctor is just trying to give me false hope. I need to go home and prepare for my death.”

A S S I G N M E N T : What should you do? How can you best advocate for this patient? Is the problem a lack of information? How does culture play a role in the patient’s decision? Does a lack of understanding on this patient’s part justify paternalism?

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