Evelyn Coleman, a lovely 49-year-old female, came to Dr. Clarke, urologist, after being seen by her primary
doctor multiple times for hematuria. After a thorough evaluation, including a cystoscopy and bladder biopsy,
Dr. Clarke determined that Evenlyn had invasive bladder cancer, which would require removal and
reconstruction of her bladder. She and Dr. Clarke talked about her options. Evelyn was surprised and
reluctant to agree on a treatment plan, so Dr. Clarke suggested that she obtain a second opinion. She
didn’t know about that. She said that she would talk with her husband of many years and get back with Dr.
More than two weeks passed before Evelyn finally called the office to speak with Dr. Clarke. She and Sam,,
her husband, had done extensive research on the Internet and had made up their minds to seek alternative
and holistic care. Evelyn told Dr. Clarke that she appreciated his help, but that she was going to a health
spa in the Caribbean where a special diet, acupuncture, meditation, and yoga were used to cleanse the
spirit, mind, and body of diseases such as hers. Dr. Clarke fought the urge to tell her that he did not believe
in such modalities, but instead told her the truth: he knew nothing about such treatments. As their
conversation concluded, he made her promise that she would return for follow up with him after the 90-day
treatment was completed.
He hung up the phone feeling much ambivalence. He believed that without surgical intervention, Evelyn
Coleman would have less than a 25 percent chance of living two yearsFour months passed, and Evelyn returned to Dr. Clarke’s office. She was tan and feeling better than ever.
However, a sample of her urine revealed blood cells just as before. She agreed to another look into her
bladder. A repeat biopsy confirmed the high-grade invasive tumor. Dr. Clarke called her with the biopsy
results. He said, “Evelyn, you have a killer cancer that doesn’t appear to be going away.” She responded,” I
have simply never felt better! What about trying the treatments for another three months?”
Dr. Clarke had had it. He believed that Evelyn was making a big mistake. “You are really making me mad,”
he said. “This is not a personal thing. I just want you to get this taken care of, anywhere, but soon. You are
running a huge risk. It really looks like I cannot be your doctor anymore!” She replied softly, “Then who will
be my doctor?”
Dr. Clarke’s head was spinning as he left the office that night. “Damn her! I wonder if I could have done
more? Is she in denial or what? Does she really believe in this stuff?”
Post your response to the questions listed below. Your post should be well written and a minimum of 400
words. For this assignment, you do not have to post replies to your classmates’ comments.
Do you think that the patient was given enough information to make an informed decision?
Going outside of the US, do you think the patient was given enough information on that end to make
Do you feel the physician is wrong in getting frustrated with this patient?
What obligations does this provider have to the patient at the time he states he no longer can be her
Providers and patients don’t always see eye to eye; what advice from a clinical ethics resource would you
give to the provider on a situation like this?