Question

Leyla Ansari, 30, a recent immigrant from Afghanistan who is 22 weeks pregnant, is admitted to East Valley Hospital-a large, suburban, non-teaching --with severe cramping. A preliminary ultrasound indicates brain abnormalities with her fetus. She is accompanied by her husband of eight years (also an immigrant) and her mother, who speaks no English and lives with the couple. Mrs. Ansari (Leyla) also speaks very little English, though she does understand some; her husband speaks English better than his wife and mother in law. Their primary language is Dari. Mrs. Ansari is stabilized, and further scans are conducted on the fetus. The physicians soon discern that the fetus is afflicted with a relatively severe encephalocele; its size and location make survival outside the womb extremely unlikely. The attending physician, Dr. Fox, is not previously acquainted with the patient, since any earlier prenatal care she obtained was inconsistent and not at this facility.

Dr. Fox enters Mrs. Ansari's hospital room, where he noticed instantly that she was nervous. Before Dr. Fox begins to speak, Mr. Ansari, noticing a look of deep concern on the doctor's face, asserts that his wife is sick with fear and anxiety and that she herself would prefer that her husband handle any news of the situation. He requests that Dr. Fox meet separately with him first, outside of his wife's room. Moreover, it is the traditional time for Muslims to offer prayers, and, since he and his family are devout Muslims, they would prefer to do so before any difficult conversations are had with the doctor. Mrs. Ansari, obviously upset but remaining silent, makes no visible objection to her husband's wishes. The friend also is silent. Mr. Ansari repeats his request that the doctor meet separately with him. Dr. Fox, unsure of how to proceed but not wanting to stress Mrs. Ansari further, agrees to meet the husband separately across the hall, in an empty office; but he also informs Mr. Ansari that they must talk now, for he does not have time to wait for him to complete his prayers. Mr. Ansari silently follows the doctor to the empty office, where Dr. Fox discloses the most recent scan results to Mr. Ansari. Dr. Fox recommends termination of the pregnancy. Stunned, Mr. Ansari sits in silence for several minutes.

After speaking with the doctor, Mr. Ansari turns to his mother in law letting her know the information the doctor told him. She believes that the medical information from the scans may be faulty, and it would be bad luck for her daughter to learn the scan results at this point. In fact, she asserts, her daughter may "lose the baby" from stress over the results. She wishes for the hospital to keep her stable and let the fetus continue to grow inside her uterus in order to see "what God intends." She herself firmly believes (though there has been no information in this regard) that this baby is the long-anticipated boy that the entire family has been hoping for, and that God would not visit such an unhappy result on such a devout family.

Mr. Ansari then turns back to Dr. Fox and insists that the doctor refrain from telling Mrs. Ansari the scan results, assuring him that he will tell his wife himself once she is emotionally ready for the news. The doctor, increasingly frustrated with the direction of the conversation, informs the husband that such a choice is not his to make. He gets up and proceeds back across the hall, where he walks in on Mrs. Ansari awkwardly performing her prayers. Dr. Fox interrupts her and asks the friend (who is still present) to help him translate his news for Mrs. Ansari. He then gently but firmly informs Mrs. Ansari of the scan results, as the friend awkwardly translates for her. Mr. Ansari has stayed across the hall, and Mrs. Ansari's mother retreats, wailing, to the waiting room. Mrs. Ansari struggles to keep her tears at bay as she listens to the doctor.

Discussion Questions: Answer each question in 1 paragraph (6 sentences).

1. Was it right for Dr. Fox to agree to meet with the husband alone? Did he handle this case in the right way? Why or why not.

2. What is your recommendation as a health care provider?

3. What role does religion play in this case?

Answer 1

1.In hospital settings,to inform aj unpleasant message to the patient and family is a extremely challenging.Here, Leyla Ansara ,30yrs old ,22 week pregnant lady admitted to the hospital and her scan reports shows that her fetus has a severe encephalocele which makes the survival of the baby outside the womb difficult. In order to prevent further complication to the mother,the medical termination of pregnancy is the better option.But final decision about this should be taken by the patient and the family.And also here as per the request of the leyla's husband,Mr.ansari doctor permitting him to meet the doctor seperately, that is the right act from doctor,because we should respect and listen the opinion of the patient and family ,However doctor could have allowed the family to do prayer before talking this matter to the patient,because before informing such sensitive matters to the patient medical professionals should ensure adequate psychological support from family, it would be absent in this case as the family member donot get time to prepare themselves mentally to give support to Leyla.

2.As per above said scenario a health care worker should take appropriate measures to reduce intensity of mental shock and to help patients and family to cope with such an unexpected situations. So my suggestion would be , as a health care provider they should make a plan about disclosing the sad truth.first of all the health care worker should assess the mental and physical status of the patients,secondly we can speak to the family and need to provide time to accept the truth and can arrange counseling services if needed,finally we can talk to patient after ensuring support from family.

3.Religion Play a mojor role in these situations.many religious are against termination of pregnancy so patient May refuse such procedures.on the other hand, religions can influence patient positively by giving mental support and through faith in God, which enable them to face troubles in life.