Within this scenario is the issue of whether the physician was neglectful and unjustified in not informing the patient or his family of the typically improbably risk of death during a particular procedure. On behalf of the son, the physician ignored properly obtaining informed consent from the patient by not discussing with him all the details and risks of the procedure. On the other hand, the physician asserts that due to the extreme unlikeliness of this occurring, for him to give this piece of information to the patient would only counter his best interests (301). In order to rationalize which option would have been more “morally correct,” it is necessary to assess the physician’s decision with respect to each of the four moral principles: nonmaleficence, beneficence, autonomy, and justice.
As mentioned in the text, the anesthetist along with most doctors, feel that it is unnecessary to inform the patients of the risk of death with an angiogram because despite the fact that the chances of this are so slim, simply knowing there is a chance may influence the patient to not have a procedure that is crucial to their health. In fact, according to a study by Jansson and Fransson (1996), the mortality rate of a coronary angiography is between 0.10 and 0.25 percent. The principles of nonmaleficence and beneficence, then, appear to be covered from the doctor’s position. However, the argument being made my the patient’s son, that withholding these kinds of details from a patient is unethical, seems to imply an infringement on the other two principles, autonomy and justice. From his standpoint, the doctor is limiting the amount of knowledge the patient has about the procedure to ensure his consent, thereby compromising his autonomy. Futher, he probably would claim that the doctor is violating the principle of justice because the patient is inevitably unaware of all the costs and benefits when making the decision to agree to the procedure.
It is easy to consider the doctor negligent in not telling the patient all of the risks involved in the procedure because the patient died. Had the procedure been successful and the patient remain alive and well, if the doctor were to subsequently approach the son and apologetically admit that he neglected to tell his father that he could die during the procedure, he likely would be disinterested in this fact. Only in retrospect can the doctor be held responsible to an extent for the mishap. Also, if we were to consider the amount of remote risks that are involved in any medical exam or procedure, for example the chance of infection with any kind of injection, there would be an even greater amount of unwarranted anxiety revolving around a visit to the doctor. Therefore, more from a practical standpoint than anything else, I believe that it is not unethical for the doctor to avoid telling patients these kinds of details.
References:
Beauchamp, Tom L., and James F. Childress. Principles of Biomedical Ethics. New York: Oxford UP, 2009. Print.
Jansson, Kim, and Fransson, SG. Mortality related to coronary angiography. Clin Radiol. 1996 Dec. 51(20).
I agree with you on the assumption that the patient would have still gone through the surgery even if had the doctor told him about the slim chance of death, since the chance is extremely low compared to other surgeries or treatments in general. Also, I agree that it wouldn’t have been a problem had the patient not died of the surgery. However, I believe that doctors have the moral obligation to tell his or her patients about every risk that is involved. It is probably true that the result wouldn’t have changed just because the doctor had told him about the infinitesimal chance of death, but this is not where ethical issue arises from. I think it arises from the fact that the doctor intentionally undisclosed the information because he thought it was negligible, not because it was in cases of emergency, incompetence, or waiver as Beauchamp and Childress state as justifiable reasons (1). In Well and Good, the doctor defends himself by stating that he wanted to “reduce burden of fear and distress placed on patients,” but it seems like he is somewhat contradicting himself (2). My question is this: how can it be such a big of a burden and a huge of a fear if the chance of death is literally close to zero as the doctor himself says and thinks it’s not significant enough to be told to the patients? Can this be a legitimate reason for not disclosing information to patients? This is something to think about. In conclusion, I believe the doctor was unethical regardless of the result, and I agree with the son who stated that “patients have a right to be given full information about any procedure to which they are subjected,” since it is infringement of autonomy given that his father was competent (2).
References:
1. Beauchamp, Tom L., and James F. Childress. Principles of Biomedical Ethics. New York, NY: Oxford UP, 2001. Print.
2. Thomas, John E., Wilfrid J. Waluchow, and Elisabeth Gedge. “Case 10.3 Should Patients Be Informed of Remote Risks of Procedures?” Well and Good: A Case Study Approach to Health Care Ethics. N.p.: n.p., n.d. 300-01. Print.
I also agree with Jeongseok that doctors are morally obligated to disclose any possible risks associated with surgeries or treatments to their patients. However, where do you draw the line as to how much information to reveal to the patient? Even if there is less than a 1% chance of something happening, is it necessary to tell the patient and possibly worry them? Or should it be in the patient’s control to decide whether to go through with the procedure after understanding all potential risks? I believe that it is probably best for doctors to maintain a standard of conduct and disclose any possible risks involved.
In regard to how much information to tell the patient, I feel that it is safest and most ethical to inform the patient of all the possible risks. I do not feel that the doctor should withhold risks under the impression that he/she thinks the patient would agree with his/her standpoint. I do not think the concern of “worrying” the patient should be one that is superior to the concern the family will feel if a tragedy occurs and the patient dies, like the case presented. I think it is important for the doctor to present the information in a manner that is objective and not in manner that could be portrayed as coercive. The doctor should simply state the percent chance of death from the surgery, along with the percent chance of death without the surgery and let the patient decide (if the patient is competent). Furthermore, I think the doctor should comment that this surgery does not have an elevated risk of death, in comparison to other surgeries. The doctor should explain that with any surgery there is a risk of death and that it is up to the patient to decide on proceeding with that risk. I feel this policy would best support the principles of autonomy and justice. In addition, I feel non-malefience and beneficence would also be supported as the doctor is allowing the patient to cater the care he wishes to receive. The doctor is technically “doing no harm” as he is not harming the patient more by not doing the surgery. He is simply following the wishes of the patient. The argument that if the doctor does not interfere than the patient will get worse and thus the doctor is not abiding by non-maleficence is a flawed argument. Consider the argument that not interfering is equivalent to doing harm. If this argument were true than each person is responsible for the infinite harms that go on by not interfering. For example, by not donating food to shelters, one could argue that this individual is doing harm by acting as a bystander to the starvation that is occurring. Under this framework, morality loses meaning because all individuals become immoral.