Mr.w is a 70 year old Chinese American man who lives with his wife of 40 years.
Mr. w was diagnosed with lung cancer two years ago, but is now failing rapidly.
He is very weak.
Ha can no longer eat due to increased difficulty swallowing and breathing.
He does not complain of pain, but his wife says that his back hurts.
His two sons live nearby.
His daughter moved in recently to help her mother care for him.
Mr.w is primary care physician wants to make a referral to hospice services.
Mr. w says the doctor must talk with his sons first.
In a telephone conversation with the sons, the sons agree to hospice services.
However,the older son does not want his father to know he is dying and does not want the word"death" to be used when talking with his father.
The son tells the doctor, "We do not tell our father that he is dying. Telling him is harmful, causing undue emotional burden for him. We are responsible for protecting him from harm."
Mr. w does not talk part in the conversation nor does he make his wishes known.
Mr. w does not have an advance directive.