A Clash of Medical Cultures

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Editor’s Note:[1]

This column presents a problematic medical-surgical case that may pose a medical-ethical dilemma for patients, families, and healthcare professionals. As this case is based on a real medical situation, identifying features and facts have been altered in this scenario to preserve anonymity and to conform to professional medical standards. In this case, a family wishes to offer cultural treatment rather than continue traditional American treatments.

Question: Should we go to court to prevent this Samoan man’s family from taking him home against medical advice?

Story:

Tuiasosopo is a 39-year-old Samoan agricultural worker who was admitted 7 weeks ago after two weeks of headaches and intermittent nausea and vomiting and blindness for 24 hours. He was found to have cryptococcal meningitis[2] and has been treated with 2 standard antibiotics for this uncommon infection (amphotericin intravenously and flucytosine by mouth). He initially had gradual improvement, demonstrated by repeatedly testing of his spinal fluid and considerable improvement in his mental status. He was nearing the end of his 6-week course of treatment when 1 week ago he suffered a stroke. This precipitated vomiting which precluded retention of his flucytosine for several days. He has subsequently had a worsening of the spinal fluid test, and his mental status is again severely depressed. Immunosuppression[3] is suspected, but no source has been found.

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