medical ethics situation

You are a physician. An elderly patient under your care has been suffering from weakness, and tests determine that the cause of his symptoms is a progressive neurological disease for which there is no effective treatment and that is ultimately fatal. At the patient’s request, you discuss the outcome of the diagnostic tests with his family first, before you talk to the patient about them.
During your discussion with the family, family members state that they do not want the patient to be told the diagnosis. They say the family has recently emigrated from another country and that in their country of origin, it is common for a serious diagnosis to be withheld from a patient, especially if he is elderly, in order to avoid upsetting him.

In this situation could you keep the information from the patient unless they asked?

Reply 1

Chlorophile

I think it's extremely unethical to withhold that kind of information from the patient. Of course it's upsetting, but I would infinitely rather know about it than not. The family has no right to withhold this kind of information because they are not the patient. It doesn't matter what the norm is in their country of origin. I believe that everyone should have the right to control decisions about them, and in order to make decisions you need to have knowledge.

Reply 2

UKChicken

Speak to family- show them that you understand their viewpoint/custom in their country of origin but explain why it is important for the patient to know. For example the patient is still able to interact and although progressive, the condition is still at its early stages . Consequently, at this current stage the patient would be in the best position to discuss things/ make decisions as opposed to when the neurological disease has progressed to its final stages where the patient may no longer be able to interact.

Tell them that you understand the news will be terribly upsetting for the patient but remind them that a lot of ongoing support will be given I.e. psychological, social and mental support will be given He will also be able to discuss any concerns and end of life care/palliative care etc

I think it is important to try and sit down with the family to show them that you main priority is the best interests of the patients so they don’t end up feeling like you have just ignored what they have said/ they are not involved and their opinions do not count for anything.

Worse case scenario - ignore families view- family now left feeling like their opinions do not count/ they are not involved- you tell patient- patient gets upset and extremely distressed (they are already old so this is not good) - patient says they did not want to know and asks you why you did not just listen to their family :pierre:

LOL

So to summarise LOOL I would tell the patient but make sure the family knew why and didn’t end up thinking that it is because their opinions don’t count but rather because I wanted to act in the patients best interests.

If a very very elderly patient only had a few hours/a day left I doubt I would tell them as I don’t see any benefit and it could cause them a lot of distress but I’d speak to other members of the multidisciplinary team :perv:

medical ethics situation

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