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The 'Just Do It All' Request

A patient with capacity has expressed a desire for comfort-focused care, but their child at the bedside insists that you 'do everything.'

  1. 1
    Briefing
  2. 2
    Simulation
  3. 3
    Feedback

How This Works

This is an interactive phone call simulation. You'll speak with Susan in a realistic clinical communication scenario.

1. Start Call

Click "Start Call" when you're ready. Speak naturally as you would on a real call.

2. Have the Conversation

10 minutes to complete the call. The AI responds in real-time to what you say.

3. Get Feedback

End the call when finished. You'll receive AI-powered feedback on your communication.

💡 Tip: Speak clearly and at a natural pace. If you need a moment to think, it's okay to pause briefly - just as you would in a real conversation.

Briefing Details

1. Learning: Upholding Patient Autonomy

Purpose of this Scenario

This scenario focuses on a profound ethical challenge: upholding a patient's wishes when they conflict with the desires of a loving family member. When a patient has decision-making capacity, their choices are paramount. Your role is to act as the patient's advocate, gently but firmly navigating the family's grief and guiding them toward honoring the patient's stated goals.

Key communication strategies include:

  • Acknowledge the Family's Love: Start by validating the family member's emotions and intentions. "It is so clear how much you love your father and want to fight for him."
  • Gently Re-center on the Patient: Your primary duty is to the patient. Constantly bring the conversation back to them. "I hear what you're saying, and it's so important. But right now, my focus has to be on what your father, the patient, has told us."
  • Use the Patient's Own Words: If possible, quote what the patient has said. "When I spoke with your father this morning, he was very clear. He told me, 'I've lived a long life, and I don't want any more machines.'"
  • Clarify the Goal: Reframe the goal from "doing everything" to "honoring your loved one's wishes." Explain that respecting their desire for peace and comfort *is* a form of love and advocacy.

2. Scenario Briefing

Your Objective

Your objective is to have a conversation with Susan, the daughter of your 85-year-old patient with end-stage heart failure. Your patient, who has full capacity, has just told you he wishes to be DNR/DNI and transition to comfort-focused care. Susan overheard this and is now demanding that you ignore his wishes and "do everything." You must mediate this conflict at the bedside.

Patient Background

Your patient is an 85-year-old man with end-stage heart failure. He is frail and short of breath but is fully alert, oriented, and has decision-making capacity. His daughter, Susan, is his healthcare proxy but he is able to make his own decisions now.

Crucial Information: You have just had a calm, clear conversation with the patient where he stated, "I'm tired of fighting. No more hospitals, no more machines. I'm ready to be comfortable." His daughter, Susan, was at the bedside and is now extremely distressed and angry, viewing his decision as "giving up."

Key Medical Facts

  • Diagnosis: End-stage, class IV heart failure. He is on maximal medical therapy and is not a candidate for a transplant or LVAD.
  • Prognosis: His prognosis is poor, on the order of weeks to months.
  • The Patient's Stated Wish: To stop aggressive medical treatments and focus on comfort.
  • The Ethical Principle: As the patient has capacity, his decision must be respected, even if it conflicts with his family's wishes.

Learning Objectives

Optional prep details

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Optional Pre-Call Knowledge Check

Optional self-check before you start

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After completing this scenario, you will be able to:

  • Analyze the ethical principles of patient autonomy and beneficence when they conflict with family desires.
  • Formulate a communication strategy to mediate conflict between a patient with capacity and their family regarding goals of care.
  • Differentiate the roles and rights of a patient with decision-making capacity versus a surrogate decision-maker.

A patient with confirmed decision-making capacity states they want comfort-focused care. Their adult child, who is not their healthcare proxy, insists on 'doing everything.' Legally and ethically, whose wishes take precedence?

In this scenario, what is the clinician's primary role when communicating with the patient's child?

Which communication framework is most effective for exploring a family member's perspective before explaining the clinical reality?