In Case 10.3, Joe Mulroney experiences a fatal reaction to an angiogram. After Joe’s death, the anesthetist admits that he did not warn Joe of the possibility of death because the risk was so small. However, Sean, Joe’s son, argues that his father should have been told about the risk of death (Thomas et al., 2014). Should the anesthetist have informed Joe of the remote risks of the procedure?
The anesthetist violated Joe’s autonomy by withholding information about fatal consequences of the procedure. Joe is considered a competent patient, yet the anesthetist does not respect patient autonomy in that he makes his own judgement in whether or not the risks of the angiogram should be provided. Joe is willing and able to give informed consent for the procedure in that he is not young, ill, mentally impaired, or unconscious, meaning that he is competent in making this decision (O’Neil, 2003). However, would Joe have agreed to the angiogram if he had known about the possibility of death? How can the healthcare professional respect a patient’s choice, when the patient is not given all of the information to make an informed decision?
Through the intentional nondisclosure of the risk of death by the anesthetist, the moral principles of beneficence and non-maleficence are not upheld. The anesthetist argues that explaining circumstances such as death can be alarming or frightening to patients and that “over 5,000 angiograms had been done there over a decade without a single fatality” (Thomas et al., 2014).
The anesthetist makes an assumption based on a single encounter with Joe that he is “a very reasonable man, and most reasonable people choose the angiogram” (Thomas et al., 2014). Just because the anesthetist characterizes Joe as a “reasonable” man does not give him the authority to withhold the remote risks of death. The anesthetist is making a clear choice to withhold information from Joe.
Despite there being three legal exceptions when health professionals are explaining informed consent, none of them apply in this scenario. In the situation, Joe is not in a case of emergency, he is competent, and has not waived his rights. Even though Joe gave consent to the procedure, he was not fully informed when making his decision. One controversial exception related to the topic of informed consent is the therapeutic privilege, which states that a “physician may legitimately withhold information based on a sound medical judgment that divulging the information would potentially harm a depressed, emotionally drained, or unstable patient” (Beauchamp & Childress, 2009). The facts of the case do not lead us to believe that Joe falls under this category, meaning that the therapeutic privilege does not apply in this situation. The anesthetist thought he was preventing the patient from harm by not providing the information about the risks of death, but I agree with Sean in that it is the responsibility and obligation of the health professional to explain any and all risks of procedures when patients are competent and stable. The anesthetist should not necessarily be blamed for Joe’s death, but should have explained the possibility of death before Joe consented to the angiogram procedure.
Works Cited:
Beauchamp, T. & Childress, J. (2009). Principles of Biomedical Ethics. Oxford University Press, 7, pp. 127.
O’Neill, O. “Some limits of informed consent.” Journal of Medical Ethics 29.1 (2003): 4-7. Web.
Thomas, J.; Waluchow, W.; Gedge, E. (2014). Well and Good. Broadview Press, 4, pp. 300-302.
Rylee,
I think you make a great and logical argument here, with a lot of good evidence regarding medical regulations involving healthcare professionals and competency. I completely agree with the position you take in this case as well. Considering that Joe is a competent, level headed individual in this scenario that currently has no serious medical conditions that could impair his judgement, he absolutely has the right to know about any possible risks that may arise during his upcoming procedure. As a medical professional, you are robbing someone of their autonomous right to make a decision regarding a procedure done to their own body by not properly informing them of all possible outcomes to said procedure.
While I, and you in this case, do recognize that a medical professional can forgo the explanation of possible complications, none of those situations apply here making this very unreasonable that Joe was not informed beforehand. As a patient, we trust our medical professionals that are taking care of us and we have the upmost confidence in their ability to communicate with us on all aspects of our health; even if they are very small and likely insignificant facts. The anesthetist here is not to blame, but he/she made assumptions that are not necessarily true. Would Joe have asked more questions about the procedure had he known the possible consequences? Would he have even opted out possibly? In the medical field, assumptions on behalf of completely coherent and competent individuals is pointless, seeing as a patient has the ability to speak for his/herself.
In a manuscript published in the British Journal of Medical Practitioners, research showed that “Patients who have not been warned of risks involved in a course of treatment traditionally had to establish that, had they been properly informed, they would have opted for a different path” (Barton-Hanson, 2015). Now, while many of these patients in this study were involved in more complex procedures with slightly higher failure rates, the main idea of the statement still holds true and this case could have possible had a different outcome had the autonomy of the patient been upheld respectfully. In the medical profession, there needs to be a standard of telling all patients (unless directed otherwise by said patient), no matter the level of the risk, the possible consequences of a procedure. In this situation, I agree with Joe’s son entirely. Even though it is impossible to tell if Joe would have opted out of the procedure given the correct information, he still deserved to be informed to the best ability of the anesthetist.
Works Cited:
Barton-Hanson, Jem, and Renu Barton-Hanson. “Causation in Medical Litigation and the Failure to Warn of Inherent Risks.” British Journal of Medical PractitionersA834 8.4 (2015): n. pag. Print.
Beauchamp, Tom L., and James F. Childress. Principles of Biomedical Ethics. New York, NY: Oxford UP, 2001. Print.
Thomas, John E, et al. “Case 10.3: Should Patients be Informed of Remote Risks of Procedures?” Well and Good: Case Studies in Biomedical Ethics, Broadview P, 1987
Hi Rylee,
I agree wholeheartedly with your points on why the anesthetist was in the wrong for not telling Joe about all of the risks. I very much liked how you said “Just because the anesthetist characterizes Joe as a ‘reasonable’ man does not give him the authority to withhold the remote risks of death.” I think that statement is so important in this case because people make the wrong assumptions about other people all the time.
I understand that he might have had 5000 successful angiograms in the past and that the risk of death is very low, but you never know who will be that 2%. Personally, if I were Joe I would have wanted to know about all of the risks. And yes I probably would have chosen to ignore the risks, but what if, for some reason, I chose not to do the angiogram because of that risk. The anesthetist would be wrong in his assumption and cost me my life without giving me full informed consent because he thought I was reasonable to do the procedure. I think that having that choice, even if not recommended or in the best interest, is important in respecting patient autonomy.
Works Cited:
Thomas, John E, et al. “Case 10.3: Should Patients be Informed of Remote Risks of Procedures?” Well and Good: Case Studies in Biomedical Ethics, Broadview P, 1987