At the request of the attending physician, the palliative care team suggested convening a family meeting with the couple and their sons, but the sons declined the meeting. The sons explained that the dynamics of the family were such that their father's role was a gender-based traditional cultural role. Their father was reluctant to bring up end-of-life issues for fear of their mother losing hope. The sons felt that their mother had been keeping a strong front as a means of protecting her family. She had a reputation with both friends and family of being a strong, capable woman. At work and in her community, others frequently turned to her for support and advice.
The palliative care social worker introduced the Go Wish cards to the patient and spouse with the suggestion that they choose some that were most important to Mrs. M, and to think about whether other important things were missing from the deck. The pack of cards was left in room for the family to use when the patient was feeling like talking. The sons later commented that they were grateful and appreciative that the cards were available to review and discuss as the patient's condition declined. The simple but direct statements on the cards made it possible for them to talk with their mother about her hopes and wishes. She still felt strongly about wanting to have family around and wanting to help others, so they arranged for many extended-family members and friends to visit. Mrs. M gave each visitor blessings and asked them to look after her husband and sons. As the family saw her condition worsening, they felt there was no "unfinished business" and requested that no resuscitation attempts be made at the time of her death.