Ethical Dilemma - I have no idea what to do

[deleted329605]

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First, I would just like to say to the forum jingos, I am not trolling. I swear on everything.

This is a situation that I am currently in. And I have no idea what to do. And I know that ultimately, what I do has little or no consequence on the final outcome of the whole ordeal, but still, this entire situation tugs at my heart strings and I cannot sit helplessly doing nothing. Know that I've thought long and hard about what to do, and have come up with no answers. What I thought I would do in this type of situation, well, it just does not seem appropriate. So, I pose this situation to the SDN think tank, on what the heck I should do.

For the past few months, I have been traveling the world. Recently, I came to London. Here, I met a girl, a Thai girl, and she graciously gave me a place to stay in her apartment, free of charge. I've been here almost 3 weeks now. Since I've been here her roommate, also Thai, and a transgendered woman, has been feeling sick. She would lie in bed, all day, with cold sweats, back pains, fevers, etc. The roommate speaks almost no English, has been in England for 3 months (and she no longer has a visa), is in her late 20s, and is a working girl. She had a hard life in Thailand, and came here because there is a lot of money. For transgendered woman in rural Thailand, she told me, there is nothing you can be besides a working girl in order to make an actual living.

Finally, after 2 weeks of feeling ill, she went to the university hospital. My Thai friend told me that they found out she has stage IV breast cancer. How ironic and twisted, that a person who their entire life has strived to be a woman, have breast cancer (I know it is incredibly rare in genetic males). The transgendered woman's boss, the one who was told by the doctors that she has stage IV breast cancer (to translate it to the transgendered woman) was planning on sending her back to Thailand because she was not working enough. She decided, along with my friend, that she not be told about the breast cancer, because it would "break her heart." I am unsure if the doctors know that their patient, the transgendered woman, doesn't know.

I know that the survival rates of this type of cancer are low. Apparently, it has spread to her stomach and her intestines. But at the same time, it feels wrong to just stand aside and let this all unfold this way. I know my friend and the transgendered woman's boss have the best intentions in mind for her, and are at worst simply confused and upset to act in the "right" way.

 

[sinombre]

This obviously doesn't belong on this forum. But I would tell her the truth in a heartbeat. Withholding that kind of information from someone is untenable.

 

[LizzyM]

This obviously doesn't belong on this forum. But I would tell her the truth in a heartbeat. Withholding that kind of information from someone is untenable in my culture.

Unless you are familiar with Thai culture surrounding delivery of bad news, cancer and terminal illness, you really can't say whether this is acceptable or not for these people.

 

[EnginrTheFuture]

This obviously doesn't belong on this forum. But I would tell her the truth in a heartbeat. Withholding that kind of information from someone is untenable.

+1

You tell the person the truth they seek. She went to a doctor, the doctor wanted the information translated to the patient. To withhold that information in transit is not ethical in my opinion.

edit: I suggest you talk through this with the friend withholding the information.

 

[La Presse]

This obviously doesn't belong on this forum. But I would tell her the truth in a heartbeat. Withholding that kind of information from someone is untenable.

+1

Your thread made me sob. Oh--and welcome back.

 

[deleted329605]

This obviously doesn't belong on this forum. But I would tell her the truth in a heartbeat. Withholding that kind of information from someone is untenable.

I know this is not the normal subject of conversation for the sdn md forum. I've been a forum poster for a long time, and for some strange reason, I didn't know a better source to turn to that SDN. People with some experience in these types of situations, and many people to comment potentially.

I agree that withholding this information is difficult to defend. But at the same time, I've known this person for a few weeks, and not even all that well. Who am I to go behind the back of her friends, who know her better? I don't have the authority of a doctor to do something like that. And really, when you weigh the benefits, what good really would come from me doing that? Is this the therapeutic privilege in action?

 

[LizzyM]

I know this is not the normal subject of conversation for the sdn md forum. I've been a forum poster for a long time, and for some strange reason, I didn't know a better source to turn to that SDN. People with some experience in these types of situations, and many people to comment potentially.

I agree that withholding this information is difficult to defend. But at the same time, I've known this person for a few weeks, and not even all that well. Who am I to go behind the back of her friends, who know her better? I don't have the authority of a doctor to do something like that. And really, when you weigh the benefits, what good really would come from me doing that? Is this the therapeutic privilege in action?

There is no therapeutic privilege in action here. The madam who was serving as an interpreter chose not to correctly interpret the physician's words to the patient. Let that be a lesson to anyone who uses family, friend or employer to interpret for a non-English speaking patient.

In some cultures, it is believed to be harmful to the patient to deliver bad news about a grim prognosis. However, the patients often report that they know and they maintain the façade of not knowing in order to protect their loved ones from the pain of this shared grief. I think that it may be unethical to force information on to people of another culture because that is the "right" thing to do in your culture.

In reality, what can you do? Do you even speak the same language as this sick person? Would you go to the doctor and say that you've been told that the interpreter withheld information from the patient? This is a sad story but I don't know what you think that you can do to make it right.

 

[sinombre]

Unless you are familiar with Thai culture surrounding delivery of bad news, cancer and terminal illness, you really can't say whether this is acceptable or not for these people.

You raise an interesting point. The ethical issue here seems to revolve around whether or not withholding information from this person respects her autonomy. If it is a cultural norm for people in Thailand to withhold bad news like this, and so it can be reasonably assumed that the person at hand would actually want this information withheld, then withholding this information would be tenable because doing so would respect her autonomy. If on the other hand withholding this information would violate this person's wishes, I don't think withholding it would be acceptable regardless of the cultural context.

Cultural differences might create a lot of morally gray area, but I think violating the autonomy of an individual (at least to this degree) really is untenable. Again, I'm not saying withholding information from this person actually is violating her autonomy, but if it is, and it were me, I would find a way to communicate the withheld information.