Confronting a Fetal Abnormality
by Karen Peterson-Iyer
Leyla Ansari, 30, a recent immigrant from Afghanistan who is 22 weeks pregnant, is admitted to East Valley Hospital-a large, suburban, non-teaching hospital--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, though somewhat haltingly. 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 she had been meeting with an Afghan female friend (who apparently also speaks English reasonably well) while waiting for news of the fetus with her husband and mother, all of whom appear agitated and anxious. Mrs. Ansari's other children (all girls, ages 2, 5, and 6) are in the outside waiting area, accompanied by an aunt. 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 several moments, there is a knock on the door from Mrs. Ansari's mother. She immediately discerns from the husband's face that something is terribly wrong, and asserts (in Dari) that her daughter must not be told anything of the situation until she is in a better frame of mind. She converses for some time with Mr. Ansari, becoming increasingly agitated through the course of the conversation. Dr. Fox eventually interrupts and asks the husband to translate, which he does, relaying that Mrs. Ansari's mother insists 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.
Found at: http://www.scu.edu/ethics/practicing/focusareas/medical/culturally-competent-care/fetal-abnormality.html
Leyla Ansari, 30, a recent immigrant from Afghanistan who is 22 weeks pregnant, is admitted to East Valley Hospital-a large, suburban, non-teaching hospital--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, though somewhat haltingly. 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 she had been meeting with an Afghan female friend (who apparently also speaks English reasonably well) while waiting for news of the fetus with her husband and mother, all of whom appear agitated and anxious. Mrs. Ansari's other children (all girls, ages 2, 5, and 6) are in the outside waiting area, accompanied by an aunt. 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 several moments, there is a knock on the door from Mrs. Ansari's mother. She immediately discerns from the husband's face that something is terribly wrong, and asserts (in Dari) that her daughter must not be told anything of the situation until she is in a better frame of mind. She converses for some time with Mr. Ansari, becoming increasingly agitated through the course of the conversation. Dr. Fox eventually interrupts and asks the husband to translate, which he does, relaying that Mrs. Ansari's mother insists 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.
Found at: http://www.scu.edu/ethics/practicing/focusareas/medical/culturally-competent-care/fetal-abnormality.html
No, the Easy Valley Hospital did not approach Mrs. Ansari's situation in a manner that is sufficiently respectful of her culture and her family's. I understand that Dr. Fox has the job to deliver news to the patient wether that be good or bad. However, the way he went about it was unprofessional. To interrupt both Mr. and Mrs. Ansari's prayer was rude. This is part of their religion and something they take very seriously. Doctors should be able to stay calm in these situations and be able to hold professional conversations in order to come to a mutual agreement. Instead Dr. fox was easily frustrated, ignored Mr. Ansari's wishes and instead asks a friend to awkwardly translate this saddening news to his wife without his presence.
ReplyDeleteI agree that Dr. Fox handled this situation very poorly. Especially since he barged in and awkwardly made the friend translate this terrible news to Mrs. Ansari, and even did it without her mother or Mr. Ansari. Dr. Fox should have been much more aware of their wishes and he should have respected them more.
DeleteI agree with you. It was very rude for Dr. Fox to interrupt their prayers. He needed to take in the cultural considerations of his patients. Also it was very rude of him to make a friend translate the news to the wife. That puts the friend in an uncomfortable situation that they should not have to be apart off.
DeleteThe way the that Dr. Fox and the East Valley Hospital went about this situation was very unprofessional. First of all, Dr. Fox was not previously acquainted with this patient and he never introduces himself. A lacks respect for the patient. It happened twice where he interrupted their prayer. He is also not good at keeping his emotions discreet. There is one instense in specific that stick out to me. When Dr. Fox first is in the other room with the husband and Mrs. Ansari's mother he gets frustrated. Instead of remaining calm, he walks out of the room. This is very rude and unprofessional.
ReplyDeleteI agree I think that Dr. Fox was very unprofessional and that he should have never have interrupted prayer as it essential to their culture and way of life. His emotions and responses to emotions are also very poorly handled.
DeleteI agree that Dr. Fox did not handle the situation well. He should have introduced himself and respected their culture. I strongly agree that he was unprofessional throughout this whole situation and should have apologized.
DeleteI completely agree with you that the doctor should have been more considerate of the family and their religion. He was extremely unprofessional and should be corrected for his poor decisions. I definitely agree that he was very very rude and extremely unprofessional.
DeleteThe hospital and Dr. Fox where unprofessional while treating Mrs. Anasari. Dr. Fox did not respect her religion which is very important to many cultures. He also was not sympathetic at all while telling the patient and the family that the solution is to terminate the baby. He should have discussed why this is and spent more time with the family. Doctor's should know how to deliver news to the patients and should be respectful of their wishes. I understand that he had other patients to see but, he still shouldn't have interrupted them. I believe that this family was not treated with respect and Dr. Fox should have seen that he was in the wrong and should apologized to the family.
ReplyDeleteI agree that the hospital was very unprofessional about this situation. They need to do a better job treating there patient's and they should be ashamed for how they treated this patient.
DeleteDr. Fox should definitely apologize for his rude behavior and the disrespect toward the culture. I am not sure why he did not value their beliefs but he should have handled this situation completely differently and did what the family asked of him.
DeleteThe hospital and Dr. Fox should be ashamed of the way they treated Mrs. Anasari. They were extremely unprofessional. They had no respect for her religion. He delivered news to the family in a disrespectful way, not showing any sympathy to the family when they had to kill the baby. I don't care how busy a doctor is, the medical teams number one goal is to give the patient's the best treatment or service they can. Doing this was not giving them good service and they are very wrong for what they did to that family.
ReplyDeleteI agree with you saying that they did not respect their religion. Because when Dr. Fox busted into the room to tell Mrs Anasari about the problem with the baby, which he shouldn't have, he rudely interrupted her prayers. They said that they only wanted to hear this information after their prayers, so by him doing this is competently disrespecting these wishes.
DeleteDr. Fox did not go about this how he should at all. He needs to understand that people have different cultures/beliefs from what he is accustomed to. He seemed very unwilling to acknowledge their religion or even give them prayer time regarding the situation. He should have respected their wishes and not totally ignored the mother and stormed in and broke the news. This is not how you should treat anyone especially when they might lose their baby.
ReplyDeleteThe reason that this did not go as it should have is because of the lack of communication. When Dr. Fox and the husband went to the other room to talk, they should have brought the friend of the wife with them so that she could help them communicate better. During this meeting the husband should have better informed Dr. Fox his wishes for this information to be held from his wife. However, Dr. Fox should not have said anything about the pregnancy to the wife if he was explicitly told not to by the husband because it was part of their culture for the husband to be in control of decisions.
ReplyDeleteI agree that there should have been better communication between them. The doctor obviously did not understand the wishes of the family which means they should have better communicated that better. I also agree that he should not have told them because it is their culture and he needed to respect that, which he did not.
DeleteThe way the doctor and the hospital went about this situation was very wrong. I think the doctor should have listened to the families wishes instead of ignoring them and doing what he wanted. He disrespected their culture and beliefs by doing this which made him seem very unprofessional. The family was concerned about the well being of their family and was doing what was best for her and the doctor completely ignored that and did what was best for him.
ReplyDeleteDr. Fox handled this situation incorrectly. I do not agree with his actions and he should have taken the families wishes more seriously. He should not have barged in while the family was praying because religion is a sensitive topic that people need to be more carful of. He should have waited to start talking until after the family was finished with their prayer, especially in a time like this. Dr.Fox was extremely unprofessional and represented the hospital poorly.
ReplyDeleteI also do not agree with Dr. Fox's actions, as he completely ignored the family's wishes and wants. It was very inconsiderate of him to interrupt her prayers as their religious beliefs needed to be respected. Dr. Fox is not only leaving himself a bad reputation, but the entire hospital.
DeleteDr. Fox has fixed himself into some trouble with the unprofessional way he went about treated the Ansari family. First of all, he should have introduced himself and should have gotten more familiar with Leyla and all of her previous doctor appointments elsewhere. BY knowing her medical history, or at least having her explain these appointments, he would understand any previous complications and how they may be the root of the problem for this particular situation. In order to do so, he should have also gotten her a translator to help break down the language barrier so that the already unclear information could have become a bit more clear. Dr. Fox should have also respected Mr. Ansari's wishes to pray before they talked because this is a part of his religious beliefs. Dr. Fox was also wrong to rush into her room and tell the mother the news himself because her husband and mother wanted to tell her, or at least be present when she received the news to help comfort her. Overall, Dr. Fox needed to be more respectful and considerate of the family's wishes and religious beliefs.
ReplyDelete