A 38 year old hospital clerk develops renal failure due to bilateral ureteric obstruction by carcinoma of the uterine cervix. Previous therapy over the past year included three operations for tumor resection, four courses of chemotherapy, bone marrow transplantation and a course of local radiation. There are extensive liver, lung, and bone metastases. Both consulting oncologist and radiologist state that neither further chemotherapy nor radiation is indicated. The collaborating urologist, unable to catheterize either ureter states that he will perform cutaneous ureterostomies providing that dialytic therapy is initiated. The patient is weak, frail, depressed, and barely communicative. Her family states that she has been withdrawn and disinterested in family matters for four months. An on call nephrologist noting advanced hyperkalemia and a serum creatinine of 21 mg/dl declines dialysis on the grounds that “death in uremia is kinder than death from cancer.”
KeywordsCervical Cancer Palliative Care Advance Directive Obstructive Uropathy Family Matter
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