Ever right for DR to withhold truth?

[KHep]

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I'm just curious what you guys think. This is something that we have been discussing in my biomedical ethics class. Seems like a lot of people think that it is OK to withhold information from someone with a terminal illness, but then turn around and divulge all info to the family.

I see that as being problematic...passing the buck...not respecting the patient...etc.

Tell me what you think.

 

[UNE2009LMD]

I'm just curious what you guys think. This is something that we have been discussing in my biomedical ethics class. Seems like a lot of people think that it is OK to withhold information from someone with a terminal illness, but then turn around and divulge all info to the family.

I see that as being problematic...passing the buck...not respecting the patient...etc.

Tell me what you think.[/QUOT

We discussed this many times too in my medical bioethics class when I was an undergrad...I love debate.

It's vital to look at each situation on a case-by-case basis b/c it would be jumping the gun trying to generalize....For ex, a 5 year old is terminally ill. The physician tells the parents. Should the physician tell the child? I don't think it's right to do so. Yes, the parents should know but b/c the child is just that...a child, info should be withheld. Now, it's up to the discretion of the parent'swhether they should tell their child.

Now, if we switch the scenario around and the terminally ill patient is not a minor...say 60 years old...a physician MUST tell the patient. Of course, we CANNOT discriminate by age. Rather, it's a matter of doing what's best in the interest of the patient....whether a child or an adult.

 

[medic170]

I'm just curious what you guys think. This is something that we have been discussing in my biomedical ethics class. Seems like a lot of people think that it is OK to withhold information from someone with a terminal illness, but then turn around and divulge all info to the family.

I see that as being problematic...passing the buck...not respecting the patient...etc.

Tell me what you think.

No, never. it is called Informed consent and I do not see how ANYONE could EVER justify withholding info from a patient.

 

[PublicEnemy]

not sure exactly where i am on all this. i don't think it would be appropriate to actually withold information that would affect treatment or quality of life and other major decisions that are fundamental rights to patients, even if family members are being informed.

but i know at the hospital i work at we were discussing something similar at a tumor conference. for terminal patients with lung cancer that are either on ventilators, intubated, etc. sometimes, even though there are more treatment options, patients and families decide enough is enough. patients have a right to choose their treatment course and make major decisions upto a point when their condition no longer allows them to do so, and its at that point where family gets to decide.

in fact, if a patient or family members had prior indicated that they want a DNR or that they do not want to be on vent, when the time comes, the physician does not need to ask consent from the patient to pull the plug. various ethics rulings committees have determined that it is appropriate to take such action while the patient is sleeping and it would be considered inappropriate to wake the patient to tell them "its time."

ethics issues are a lot more complicated than the hard fast lines we try to draw. in general though, the best thing to do is to help patients and their families plan as much as reasonably possible. patients that are terminal need to make final arrangements, maybe they need a will, or need to decide ahead of time when enough is enough, do they want to go on hospice? etc.

 

[JohnDO]

No, never. it is called Informed consent and I do not see how ANYONE could EVER justify withholding info from a patient.

What about a young child, as UNE2009LMD mentioned? In that case, I think it's appropriate to tell the parents first, and then let them decide how they are going to handle it.

 

[medic170]

What about a young child, as UNE2009LMD mentioned? In that case, I think it's appropriate to tell the parents first, and then let them decide how they are going to handle it.

Right, I should have said that it is NEVER ok to withhold info from a legally, mentally competent patient. Minors, unconcious patients, or mentally incompetant patients would be the exceptions, but you still have an obligation to tell the parent or guardian everything in those situations. That is called implied consent.

 

[JohnDO]

Right, I should have said that it is NEVER ok to withhold info from a legally, mentally competent patient. Minors, unconcious patients, or mentally incompetant patients would be the exceptions, but you still have an obligation to tell the parent or guardian everything in those situations. That is called implied consent.

I agree.

 

[eldarion3141]

In my ethics class a case study was brought up:

Let's say that Bob Sanchez had alwas loved the Alps, but had finally saved up enough money to go for the first time in his life in a week. He goes to get a routine checkup from his doctor and some shots, and his doctor realizes that he has an end stage terminal disease, and that he only has a week to live. The family does not want Bob to know. What does the doctor do?

The class consensus was that the doctor withold the information and allow his patient to enjoy his vacation. The justification was that it would be in the patient's best interest to be carefree and enjoy his last few days on this earth.

My opinion was the total opposite, because if i knew that i was going to die, i would want to get my affairs in order. but this was one of the most talked about discussions that we have had this year.

 

[medic170]

In my ethics class a case study was brought up:

Let's say that Bob Sanchez had alwas loved the Alps, but had finally saved up enough money to go for the first time in his life in a week. He goes to get a routine checkup from his doctor and some shots, and his doctor realizes that he has an end stage terminal disease, and that he only has a week to live. What does he do?

The class consensus was that the doctor withold the information and allow his patient to enjoy his vacation. The justification was that it would be in the patient's best interest to be carefree and enjoy his last few days on this earth.
My opinion was the total opposite, but i just thought that this brought up a good point.

That is just sick. Who is the doctor to decide what is in the best intetrest of that patient? The patient has the right to make his own decisions. maybe he would choose to spend that week with family and friends rather than self indulgence if he knew it was his last week to live. Maybe he would want to get his affairs in order. Nobody but that person can decide what is best for them. Do these people who think withholding info is ok think they are God or something. Sheesh, every human being has the right to make their own deciosions with informed consent.

 

[richarDsOn]

I agree... if the patient is competent, then they have the right to make their own decisions about their healthcare...whether the family thinks/feels otherwise should not influence the doctor's decision to consult with the patient - first.

 

[PublicEnemy]

your class wouldn't give me or Bob the chance for a second opinion?

 

[ilona]

It also depends what you say to the patient. The best way is to say something like that "according to statistics patients that have your illness would die in 3 months. But there are cases were patients lived longer than that." If you tell patient he has 3 months he will just give up and die. If you give them hope patients may live longer. You know what I mean?

 

[medic170]

It also depends what you say to the patient. The best way is to say something like that "according to statistics patients that have your illness would die in 3 months. But there are cases were patients lived longer than that." If you tell patient he has 3 months he will just give up and die. If you give them hope patients may live longer. You know what I mean?

Yes, of course you must give them all the facts you know along with your expert opinion....without giving false hope. I think that is what you are saying here.

 

[Dr Alo]

We were always taught that you can ask the patient:
1. Who do you want in the room with you when we explain this?
2. How much they want to know about your illness?
3. Do you want to know everything or just the treatment?
4. When would you like me to talk to you about this?

This seems to be a more humane/sensitive approach. Let them decide what they want and don't want. Some people want their priest/mom/spouse in the room. Some pats. just want to know how its treated and don't want the name of the illness, some want to know everything.

 

[KHep]

I agree that all rational adults should be given all information regarding their health, but what about kids?

At what age do you share all medically relevant information with them and how do you decide?

You could have a very competent 12 year old, but the parents want to withhold information from that child. What do you do?

Or how about this...my cousin had leukemia. When she was nine her doctor recommended amputating one of her legs. My Aunt left it entirely up to her to make that decision (She says because she was the one who was going to have to live with the outcome...or not). I have a seven year old and I can't imagine that in 2 years she would be capable of understanding the ramifications of such a decision. My cousin decided not to go throught the operation and her leukemia went into remission.

Do you think that parents should leave such decisions up to their kids? Especially grade schoolers?

 

[jkhamlin]

No, never. it is called Informed consent and I do not see how ANYONE could EVER justify withholding info from a patient.

Medic, I totally agree with what you are saying on your posts, but I have a question that has troubled me and I am curious what you and others think of it:
I am sure that you are well aware that some information is virtually impossible to explain to patients depending on their education level. Sometimes you just don't know how much you can tell them without talking over their heads or dumbing it down too much. Either could be considered withholding information and is a fine line between informed and assumed consent. I have had physicians who don't know my education level try to explain things to me like I am in kindergarten. I knew they were withholding information. I then told them exactly what my education is and what I knew they were withholding and they get all upset. 🙄 In addition, I have to wonder whether cosmetic (not reconstructive - that's different) surgeons are engaging in TRUE informed consent. People really don't understand what they are getting into there.

 

[KHep]

As far as the cosmetic surgery issue goes, I think similar problems probably crop up in other fields as well. Like total knee replacement. You have an 80 year old going through it...do they really understand how grueling the physical therapy and overall recovery is going to be. How realisitic is it that they can effectively treat their pain while going through therapy?

But, I do think that overall, Drs have an obligation to arm their patients with as much info as they can...and in terms that are understandable. I think it is belittling to the patient to assume that they won't be able to understand what is going on.

I recently started shadowing an OB/GYN and he was remarking on how he can't believe that so many women have never been told what a pap smear is. He takes the time to expain that it is a screening test etc. And isn't that really what it comes down to? Time. Do Drs have time to explain procedures to patients? Should we make it more of a priority and how is that done when you are relying on insurance disbursement based on numbers of patients seen? When Drs are forced to see 7 or 8 patients in an hour, do they have adequate time to keep them fully informed?

 

[fun8stuff]

I'm just curious what you guys think. This is something that we have been discussing in my biomedical ethics class. Seems like a lot of people think that it is OK to withhold information from someone with a terminal illness, but then turn around and divulge all info to the family.

I see that as being problematic...passing the buck...not respecting the patient...etc.

Tell me what you think.[/QUOT

We discussed this many times too in my medical bioethics class when I was an undergrad...I love debate.

It's vital to look at each situation on a case-by-case basis b/c it would be jumping the gun trying to generalize....For ex, a 5 year old is terminally ill. The physician tells the parents. Should the physician tell the child? I don't think it's right to do so. Yes, the parents should know but b/c the child is just that...a child, info should be withheld. Now, it's up to the discretion of the parent'swhether they should tell their child.

Now, if we switch the scenario around and the terminally ill patient is not a minor...say 60 years old...a physician MUST tell the patient. Of course, we CANNOT discriminate by age. Rather, it's a matter of doing what's best in the interest of the patient....whether a child or an adult.

nice response