Question

George has gonorrhea. He does not want to tell his wife, but does want to protect her from the disease. While undergoing treatment, he asks the family physician to test his wife without her knowing it. When the wife comes in with a bad case of bronchitis, the physician tests her, saying, “I just want to run another test on you to rule out a possibility, a mere possibility, you understand.” He finds she has been infected and treats her without her knowing the diagnosis. He merely tells her, “I want you to take these antibiotics as a precaution.” In this way, he protects the husband. Is the family physician deceiving the wife by suppressing the information? Is his medical treatment of the wife ethical? Suppose that the disease was AIDS. Does this change the ethics?

Answer 1

Patients always have respect and trust in their doctor during their decision making period because the patients are either unlearned in medical services or they believe that doctors are better decision makers than they them self.

a patient comes back to the same doctor only when there is trust worthy bond between doctor and patient.once this trust is broken it cannot be regained.

doctors are the responsible people who talk to the patient regarding diagnosis,treatment and their prognosis.what ever is suggested by doctor is followed by patient hoping for positive outcome but what if the doctor hides information from patient.this is what exactly happened in the case of George and his wife

--withholding information from patient is a violation of doctor's role as a fiduciary an dis not ever justified.

--information is a powerful tool for both good and harm

--THERAPEUTIC PRIVILEGE-withholding of information by clinician during the consent process in belief that disclosure of this info would lead to harm or suffering of patient.but this is not ethical in all the cases as in case of the above said client

--conscious withholding of information from competent patients dis-empowers them and requires greater justification than patient welfare

--even though there is a legal recognition of therapeutic privilege it is not applicable on ethical grounds

RESULTS OF NOT DISCLOSING PROPER INFO TO PATIENT:

---disrespects autonomy

--doesn't benefit in the long run

--does harm than good

--outcome is definitely affected

--patient's right to information takes a precedence over doctor's exercise of discretion

--misguides the patient and family

--dishonesty may add to the patient's distress

--prolongs normal adjustment process there by causing harm and violating the ethical principle of non-maleficence

MORAL ARGUMENTS IN FAVOR OF TELLING THE TRUTH

--respect of autonomy

--obligations of fidelity and promise keeping

--need for trust in doctor patients relationship

MORAL ARGUMENTS NOT IN FAVOR OF TELLING THE TRUTH

--Therapeutic privilege (as discussed earlier)

--health care professionals cannot know the truth-in case they are unable to find out diagnosis or if patient is non co operative or if patient is lying about the symptoms etc

--some patients do not want to know the truth about their condition

--it is considered acceptable to hide info if doctor feels that disclosing details would cause harm to pt ,in case of kids,in case of mentally retarded people..........if disclosing the facts causes harm to the patient then it can be hided

although some courts have recognized therapeutic privilege as a way of promoting patient well being respecting Hippocratic dictum of first do no harm ,it is not ethically justified

A medical doctor being an expert appreciates ...he risk inherent in the procedure he is prescribing ,the risk of not undergoing the treatment,probability of successful outcome etc.........once this info is disclosed that aspect of an expert is done.

A patient should be denied the opportunity to weigh the risks only when it is evident that he/she cannot evaluate data  

In case of Mr.George and his wife it was not a good decision by doctor.he should have explained the couple about the disease condition and it available treatment and precautionary measures.if needed counselling sessions also could have been helpful.this would definitely bring about a great change once they accept the situation.it is definitely harmful act done by doctor.

if it was newly HIV positive patient and if the doctor had done this then it would have been a great a harm to patient and the society,the precautions will not be taken by HIV patients not to spread the disease and hence it would be a harm to society as well.........so disclosing facts to all the patients is compulsory but the way of approach should definitely differ in view of emotions of the patients..