My neighbor, Maria*, asked me to watch her house while she visited her parents. When she returned, she sunk on to my couch and dissolved into tears. Oh-oh! We have known each other a long time, so I could cut right to the chase. "What's happened?"

"It's Mom. She's a young 74, in great shape, never smoked, and we just found out she has cancer. While I was there, Mom and I saw two oncology specialists, and a chemotherapy nurse. She had a PET scan, CT scan, x-rays, a bronchoscopy, and was told she had stage 3A, non-small-cell lung cancer, squamous cell type."

"Tell me more about what's going on," I asked, hoping to learn how I could best comfort my friend.

"We were told that the cancer is not curable, but treatment could give her more time and help improve her quality of life. Mom is refusing treatment. Nothing Dad and I or the doctors and nurses said could change her mind. She won't give chemotherapy or radiation a chance. She says she'd rather have the cancer kill her than the chemo! She refused to listen to information about survival rates and statistics because she doesn't want to think of herself as another number! Is this right? What can we do?"

I listened as Maria poured out her concerns and feelings. She felt at times as though her mother was being cowardly and selfish by giving up without a fight and was thinking only of herself. "I think the real reason she won't do chemotherapy is she doesn't want to lose her hair; it's too embarrassing." But Maria also conceded that perhaps her mother's decision was based on a desire not to put the family through the long, agonizing process of watching her die. Explaining that the doctors made it clear that her mother had the right of autonomy, the right to make her own decisions, because she was a competent adult, Maria acknowledged, "She's made out her living will and durable power for attorney. She's thought it all through. So maybe she's being heroic, not cowardly."

"Maria, you asked what you could do. There are no easy answers, and things can change daily. It sounds as though you are helping her by listening, and perhaps suggesting new ideas to consider, while confirming that decisions are hers to make. For example, she may not know that more new treatments were approved for lung cancer between 2011 and 2015 than had been approved in the past 40 years. Molecular profiling is available for certain types of cancer. Genetic testing and clinical trials have led to the development of new treatments that could improve survival. Video assisted surgery (VATS), can make treatment less invasive." I gave her some websites to explore and share with her family (http://www.cancer.org/cancer/lungcancer-non-smallcell/detailed guide and http://www.cancer.gov/cancertopics/pdq/treatment/non-small-celllung).

As we talked, I felt honored that Maria had chosen to confide in me, especially because she's made it clear she doesn't want to "discuss religion." Many Christian nurses find themselves in similar positions as they give care to patients, friends, and family who are drawn to their caring spirit but find religion off limits. Christian nurses have an opportunity to facilitate meaningful discussions on Advanced Care Directives.

Ethical considerations that guided our visit included:

* supporting the mom's autonomy in decisions;

* discussing how to support families in this situation (listening well, giving more information as needed, addressing "What is right? What can a family do?"); and

* recognizing appropriate times to share faith/religion.

I listened to Maria's concerns about what she could do. I am praying that there will be a future time to address spiritual concerns. God's Word instructs us as believers to "bear one another's burdens, and so fulfill the law of Christ" and "as we have opportunity, let us do good to all" (Galatians 6:2, 10, ESV). And although Maria wasn't ready to discuss spiritual things, at some point she may be. Then I will "be prepared to give an answer to everyone who asks you to give the reason for the hope that you have" (1 Peter 3:15, NIV).

* Name changed to protect privacy. [Context Link]