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A Doctor’s Dilemma

Updated: Mar 26, 2021

By: Sahil A and Pooja R

Ethical dilemmas are more frequent nowadays, especially in the medical field. A prime example is when doctors and nurses withhold a patient’s medical conditions from the patient. Some doctors and nurses still practice this around the world, which is why this dilemma has gained popularity. This is an example of truth vs loyalty ethical dilemma. On one hand, siding with loyalty, doctors, and nurses may simply want to save the patient from stress or trauma as they feel obligated, which explains the withholding of a patient’s conditions. On the other hand, siding with truth, which is required by law that doctors and nurses communicate all medical information to their specific patients in order for the patient and the doctor to have a consensus on the treatment plan for the patient.

Truth vs Loyalty

Let's take this hypothetical situation: Mr. Ramirez, a 67-year-old Hispanic immigrant from Mexico, goes to the oncology clinic accompanied by his wife and adult son. Mr. Ramirez was referred by his family practitioner because his work up shows a lobe 4-cm mass resulting from years of smoking. Unfortunately, the oncologist confirmed the findings and the family starts a discussion.

The son, who speaks better English, pulls the oncologist aside and tells, "Please don't reveal everything to my parents because my dad will not move on." Therefore the oncologist holds back the truth and advises Mr. Ramirez to take chemotherapy. The son starts explaining that the chemotherapy is for an infection while withholding information about cancer.

In this scenario, “therapeutic privilege” is ethical because the father has a trusted individual that wants him to survive. Therapeutic privilege is a rare situation when physicians withhold medical information from patients because they believe that the disclosure will pose emotional distress so serious that it will deteriorate with the effectiveness of the treatment. However, the patient’s medical conditions will be revealed to them as soon as the patient is ready.

While over 90% of physicians agree with withholding a certain amount of information until a proper diagnosis is made, it is still ethically unacceptable. If the patient were to be mortally injured by one of their undisclosed conditions, then the doctor is held responsible and a life is lost. However, this story does not apply to all scenarios because some may not have a family.

Furthermore, the patient’s right to self-decision can only be carried out effectively if the patient has an adequate amount of information to make an educated choice. The patient is the one in control of their own treatment and it is the physician’s job to only guide the patient. Informed consent is one of the basic policies regarding ethics and law the physicians must abide by.

What Is The Right Choice?

In the end, one must follow the rules. Physicians do not have the authority to play with the livelihoods of others and should present all the cards to the patient and help guide the patient to make the right decision. If the patient chooses otherwise, then so be it. Even though a doctor could potentially avoid multiple contraindications that could waste a patient’s money or endanger a patient’s life, the risks would be far too great in some situations.

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