Senora M., an 86 year-old Hispanic female, has been a patient of yours now for the last 5 years, and you have developed a close relationship with her. You have talked about sensitive issues like end-of-life issues in the past without any of her family members present mostly because they have not been easily accessible to you since the majority of them live outside Washington State. You have discussed Advanced Directives with her, and have encouraged her to complete the appropriate forms that you have given her. 

She now lies before you in the ICU on a ventilator, in a coma, after suffering a major hemorrhagic stroke 72 hours ago. The neurologist and neurosurgeon have both informed you that further treatment is futile, and that there is no brain activity. She has shared with you in the past that she did not want any invasive procedures done to keep her alive, and requested that she never wanted to be on a ventilator. Unfortunately, she never completed her Advanced Directives. The Medical Director of the ICU, a pulmonary intensivist, recommends that you should discontinue the ventilator, and transfer the patient to the floor for palliative care. 

Her family is now here for a family conference where you are to deliver the bad news. All of her children with the exception of one son who lives in New Mexico are present. You proceed to explain her medical condition in a sensitive manner, and you are careful to explain that there is nothing more that can be done for her. The eldest daughter interrupts you, and states that nothing should be done until her brother arrives from New Mexico in 2 more days. She informs you that the family has already talked about their mother, and want you to continue providing everything possible. In addition, they have already called a local curandero to perform a limpia on their mother in the hospital as soon as possible, and have also called their local priest to perform a ritual (a blessing). 

How would you approach this situation? What are some of the questions that come to mind? What do you personally think of the family's requests? To answer these, proceed on to the next section....