Question

Paternalism Paternalism in medicine isn't prima facie bad. We count on professionals to use their superior knowledge, experience, and relative objectivity to help us. The premise is, "you know more than I do; help me. The ideal scenario assumes collaboration between doctor and patient, where communication flows freely, where a doctor uses their expertise to guide patients' decisions. The complex nature of medical knowledge and its potential for life-altering impact (and expense) argue against any patient being able to order any test for themselves. The information gained requires professional interpretation so that people can use the information wisely. A test result that sounds horrible to a patient may in fact be insignificant, and vice versa. Where are the "bright lines" in this balance? When a patient gives consent to treatment when does the doctor need specific approval for tests? What information is the patient entitled to receive? Researd

Answer 1

The Bright line

Once a patient has given consent, information must continue to flow. One cannot ethically order a test or perform a procedure and then withhold the outcome from the patient. There are a lot of grey areas in Medical Paternalism. Hence it’s helpful to see if there are any bright lines. A patient who comes to see a physician signs a general consent to treatment which covers much of what one do. A physician don’t need to explicitly ask permission to look into an ear or to analyze kidney function. These are presumed to fall under a general consent because they are relatively minor interventions that are a normal part of an exam and commonly without grave implications. Contrast this to a CT scan of the abdomen. This is a more “extraordinary” intervention, one with potential risks (radiation exposure, exposure to potentially toxic intravenous dye) and one whose results may give life-altering information (a tumor, a need for surgery, etc.).

Informed consent and Special Approval

Specific consent should be obtained for extraordinary procedures with unusual risks or high probability of life-altering results.

The piece is not terribly written, but it leaves out a lot of important information. That being said, we can assume that a genomic analysis was conducted of some children, and doctors puzzled over whether to give the results to the parents.

Ethics require that the parents (who are surrogate decision makers for the children) be given informed consent. The genomic analysis should not be done at all without informing the parents what we can or cannot learn from the test. Genetic predisposition to disease can be very mushy: it’s easy to see if someone has sickle cell anemia, but not so easy to see if they will develop hypertension.

For the purposes of this discussion, Let us assume that whatever this “dementia gene” the doctors found gives the child a very strong chance of dementia at an early age. In this case, they cannot ethically withhold this information from the parents. What if there were a “maybe, sort of” predisposition? Same answer.

In fact, if the parents gave their informed consent, and the information included the uncertainties inherent in genomic analysis, they have the right to all the results, along with interpretations from a professional who understands them. If they were not given proper informed consent, the test shouldn’t have been run. A doctor who orders a test must have it’s consequences mapped out in advance, and shouldn’t be wondering after the fact what to do with the data.

Information to Patient

There exists an expectation of doctors to provide as much information as is appropriate to their patients, as well as an expectation that they do not keep anything relevant secret. This creates a difficult legal situation in which a decision has to be made about what the correct amount of information is, and how best to present it.