Though physicians are obligated to disclose all relevant medical information to their patients, it was obvious that this young man wasn’t prepared to hear the news I had to present. He was lying on his stomach, crying, refusing to turn around to talk to me. So I told him exactly what his father had requested. Then, over several days, I eased him into the knowledge of his true condition. Doctors sometimes have to know how to keep secrets.NYT op-ed
The moral basis for withholding information from such a patient is clear: Above all, physicians must do no harm. The underlying philosophy is paternalism. Paternalism derives from the image of the paternal figure, the father, in a family. The father is motivated by an interest in his children’s welfare. He acts on their behalf, but not at their behest. The beneficiaries — his children — may even repudiate the actions taken on their behalf.
Such paternalism was once widely accepted in medicine. In the mid-19th century, the American Medical Association’s code of ethics stated that physicians had a “sacred duty” to “avoid all things which have a tendency to discourage the patient and depress his spirits.” But times have changed. The prevailing ethical mantra in medicine is patient autonomy. Today, patients own their health information. They have the right to direct their own care, and to do so they must be fully informed. As doctors, we no longer “care for” as much as “care with” our patients through their illnesses. READ MORE
Sunday, February 23, 2014
NYT op-ed: "When Doctors Need to Lie"
"I ONCE had the unenviable task of informing a 22-year-old Jamaican man that he was suffering from severe heart failure and would probably need a heart transplant. The man’s father warned me that his son would be devastated to hear the diagnosis. “It would mean a lot to me if you could go back in and tell him he’s going to be all right,” the father pleaded. “Please tell him that if he does the things you say, he’s going to be O.K.”
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Today, patients own their health information. They have the right to direct their own care, and to do so they must be fully informed.
What planet does this guy live on? Apparently, he's never heard of Obamacare.
The emotional stress of severe illness clouds everybody's judgment and ability to hear what the doctor is saying. I've been through it.
I think the doctor should deliver a plain spoken diagnosis. But, that's no guarantee that the diagnosis will be heard and understood. And, if the patient doesn't like the diagnosis, he'll find a different doctor to give him one he likes better.
I'm failing to connect what the doctor did with the headline. OK is ambiguous. But the patient did do what the doctor said, and things turned out, OK. I see the issue as more of tact. When the patient is already crying, their isn't much to be gained for anyone to go in and say, "I see your already upset, so let me give you some more bad news." A distraught patient doesn't need a running commentary on what's happening, particularly if you have some time to handle the communication at a later date.
However, the doctor is correct that issues with privacy rights has limited the handling of information to the patient. In the interest of central planning, we have created a limited set of solutions that don't fit every situation.
The 1952 film Ikiru "To Live"), co-written and directed by Akira Kurosawa, examines this issue beautifully.
A minor Tokyo bureaucrat in his 50s having stomach pains is told by his doctor that 'everything will be fine, go home and eat anything you want'. He instantly realizes this means he will die from cancer.
After flailing about a bit, he dedicates his remaining time trying to accomplish one worthwhile thing before he dies. in doing so, he found meaning and beauty.
I failed to answer the question, of course.
"It's sometimes rather complicated" is true, but boring.
I saw that movie.
Autonomy does not always keep hope alive.
Sometimes autonomy is in fact rather cruel.
But we mustn't admit that some people 'can't handle the truth.'
I bet if instead we called it 'maternalism' or discussed the multicultural differences in approaching this issue, they'd be teaching it fawningly in every medical school.
Other countries have medical systems where "autonomy" is not so highly valued, to say the least.
I've had multiple family friends & relatives in France that got a sugar coated diagnosis rather the terminal truth from their doctors, and I thought, under the circumstances, it had little to do with the patient & more to do with placating their families. The example in the article had the truth revealed to the patient in a few days after diagnosis. My examples had the truth revealed when the patient discovered s/he was falling apart at the seams after having been told otherwise.
Biiiiig moral difference.
If a doctor lied to me about my condition, I'd sue his ass off.
Pogo, do you think "do no harm" is based on (underlying philosophy is) paternalism? I don't get the connection. If anything what underlies "do no harm" is a mountain of practical experience with the unanticipated consequences that follow most any treatment. But you actually know something about this stuff's reason I'm asking YOU!!! Now don't screw up, doc!
I am meeting my oncologist MOnday morning. If he lies to me (I can read and understand, loosely, PET CR Scan results) I will kick his ass. The results are 90+% good, I want the skivvy on the 10% and what "intervention" (radiologist
's term, not mine) , if any is necessary now. I do not fear death, faced it before several times, but I expect nothing but the truth from my doctors. Period. And not in the Obama sense of that word.
Lately I have had frequent bacterial infections of sinus and upper lung nodes (two with the past 60 days) and need to know if the PET indications are influenced by that. Anything like a cold or bronchial infection can skew a PET result. Otherwise my PET came out great (no metastasis of prior cancer), prior cancer lesion is a fingernail sized scar, etc....but he upper nodule of the right lung shows "metabolic activity" (in the middle of massive pneumonia scarring)...e.g., I want the truth now, not later. The CT with contrast doesn't confirm the PET findings.
Anyone who lies to me on this topic is highly at risk.
too late. Obama's radical leftist Marxist paternalism of the all encompassing central planning of government will doom us all.
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