How far would you stretch the truth to save a life?

[dr barb]

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If you knew you could save a patient's life by coloring the truth a bit or leaving out some information, would you do it? How far would you go?

 

[doepug]

I'm not sure what you mean. Do you have an example?

 

[Mike59]

Sounds like someone needs a little "help" filling out their secondaries. 😛

 

[Purifyer]

The only light I can shed on your rather vague question is this; do you mean 'how much would you lie to a patient in order to make them choose, what is in your opinion, the best choice?'

That's the only way I can make any sense out of your question... the answer being that you are not god.

 

[sacrament]

I'm interested in neither truth nor lives.

 

[dr barb]

Originally posted by doepug
I'm not sure what you mean. Do you have an example?

Say a patient has, throat cancer. They've been told they have cancer by a number of physicians. But they're in denial that they have cancer. They don't want to deal with it. They finally go to the hospital because their cancer is preventing them from eating and they want you to help them be able to eat. So you tell them you want to treat their cancer. But they don't want you to treat their cancer because if you treat it, it means they have it, which means to them that they will die. You've tried to explain that there cancer is treatable but they just won't listen. Yet they want to be able to eat. So what do you do?
A) let them die of cancer
B)spend hours begging and pleading with them to pretty please with sugar on top take the antineoplastic
C)tell them you're going to give them medicine that will shrink the "thing" that is obstructing their throat and help them eat (conveniently leaving out the word cancer; but still telling them of the possible side effects of the drug, etc.)

 

[dr barb]

Originally posted by sacrament
I'm interested in neither truth nor lives.

Finally an honest answer!😀

 

[dr barb]

Originally posted by Mike59
Sounds like someone needs a little "help" filling out their secondaries. 😛

Actually already in med school, hence the ethical dilemma I was presented with today. Although I have changed pretty much all the details of the disease, the same scenario presented today and I was just wondering how others would have dealt with it.

 

[Purifyer]

Originally posted by dr barb
Say a patient has, throat cancer. They've been told they have cancer by a number of physicians. But they're in denial that they have cancer. They don't want to deal with it. They finally go to the hospital because their cancer is preventing them from eating and they want you to help them be able to eat. So you tell them you want to treat their cancer. But they don't want you to treat their cancer because if you treat it, it means they have it, which means to them that they will die. You've tried to explain that there cancer is treatable but they just won't listen. Yet they want to be able to eat. So what do you do?
A) let them die of cancer
B)spend hours begging and pleading with them to pretty please with sugar on top take the antineoplastic
C)tell them you're going to give them medicine that will shrink the "thing" that is obstructing their throat and help them eat (conveniently leaving out the word cancer; but still telling them of the possible side effects of the drug, etc.)

You aren't god. If a patient has such an obvious psychological problem that they are stuck in the denial stage for such a length of time, perhaps you need to refer to a social worker. Quite often in situations like this, cognition may be impaired or you have failed to explain the disease in terms the patient can understand.

In my opinion option C is (i) unnecessary (ii) trying to cover up your 'psychosocial' failings as a doctor

 

[doepug]

Originally posted by dr barb
Say a patient has, throat cancer. So what do you do?
A) let them die of cancer
B)spend hours begging and pleading with them to pretty please with sugar on top take the antineoplastic
C)tell them you're going to give them medicine that will shrink the "thing" that is obstructing their throat and help them eat (conveniently leaving out the word cancer; but still telling them of the possible side effects of the drug, etc.)

I would choose option D: schedule the patient for G tube placement and continue to educate the patient about the treatable nature of throat cancer.

Has anyone sat down with the patient and family for >30 minutes to discuss this diagnosis and its implications, or has it just been brought up in passing on multiple occasions? It sounds like the patient is not truly informed.

I would also consider possible reasons why the patient refuses to accept a diagnosis of cancer. Underlying depression? Does the patient have passive death wishes? Perhaps what the patient really needs is an SSRI +/- therapy.

doepug, MS IV

 

[ckent]

I would choose answer choice c). Just as long as you are honest and acting in the best interest of the pt, I would have no problem emphasizing one aspect of the drug (it will shrink that thing in the back of your throat) over another (it's being used to treat your cancer). You can say that it's being used to treat their cancer once, and if it really sounds like they don't want to hear the word "cancer", sometimes I find it useful just to say things in a way that pt's want to hear them said.

 

[SoulRFlare]

The problem with telling the patient that "i will give you medicine to shrink that thing in the back of your throat" is that the patient will expect to be taken off of the drugs once he is able to swallow. Then you will have to come up with some other lie in order to justify continued drug therapy, at which point the patient may become suspicious and or resentful.
if this patient is in such denial regarding his cancer, he is going to go to great lengths in order to maintain his precariously constructed sense of reality. you could possibly expect him to be paranoid toward physicians, and if you do anything to pique this paranoia--ie lie to him--you may, in the long run, do more harm than good.