the timing offered by the physicians is wrong in his case, that he will beat the numbers.

Mr. Yengley's niece was also open in talking about the illness: "I know he has cancer, pancreatic and stomach. And I know at the time he was diagnosed, he had three months to a year to live." Following his initial surgery, the health care team suggested a treatment regimen of radiation therapy and chemotherapy. Mr. Yengley began this treatment course, but stopped all treatment soon thereafter, a course he initiated because of the unpleasant side effects of treatment. Once settled with his niece, he made specific plans for his funeral and began choosing a nursing home/hospice where he could receive end-of-life care, reflecting his desire not to "die at home," which he felt would burden his family.

George Yengley's social worker highlighted the unique elements of his story. "It's interesting because he is such an exceptional guy. He is one of the very few who actually say, 'no, I don't want any more treatment.'… He is dealing with his own prognosis and he knows radiation may or may not help. He knew it didn't make him feel good so he stopped. I have a lot of admiration for that. We support his decision." Mr. Yengley's style was much appreciated by the staff, who described him as "strikingly realistic." His oncologist's comments reflect the degree of congruence between Mr. Yengley and the staff. "He very quickly showed himself to be someone who was able to make decisions for himself and not be lost in a sea of emotions."

Embedded within the new end-of-life practices are unexamined assumptions that stem from specific Western traditions. Innovations in health care ethics that emphasize advance care planning for death or a patient's right to limit or withdraw unwanted therapy appear to presuppose a particular patient. This ideal patient has the following characteristics: (1) a clear understanding of the illness, prognosis, and treatment options that is shared with the members of the health care team; (2) a temporal orientation to the future and desire to maintain "control" into that future; (3) the perception of freedom of choice; (4) willingness to discuss the prospect of death and dying openly; (5) a balance between fatalism and belief in human agency that favors the latter and minimizes the likelihood of divine intervention (or other "miracles"); and (6) an assumption that the individual, rather than the family or other social group, is the appropriate decision-maker. Patient George Yengley comes the closest to this ideal patient.

CASE NARRATIVE: Hung Long Lin

Mr. Lin's cancer was diagnosed in China before he immigrated to the United States about one and one-half years ago with his wife and their two sons. The older son attends junior college and speaks English well, always



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