In medicine, many of the moral issues that arise are based on different medical risks. Personally, I believe that it is the right of the patient to know any and all risks involved with his or her condition. However, the doctor from Well and Good Case 10.3 seems to disagree with me. In the case, the doctor failed to notify the patient of the risk of death because “in his view … death in such circumstances was rare enough that to mention it would unduly alarm patients” (Thomas, Waluchow and Gedge 300-301). Lo and behold, the patient died from the routine procedure that the doctor was to perform.
The failure of the doctor to notify the patient of the risk of death is unjustifiable for two main reasons. The most prominent of these reasons is that, as a human being with complete moral status (the patient was healthy and had no reason for anyone to question his moral status), the patient had the right to be alive. What follows from this is that the patient’s contemporaries have an obligation to not do anything that impedes on his ability to live without his express consent. In this case, the doctor did not obtain proper consent to do this procedure that threatened the patient’s life, no matter how minimal the chance of death was. While the doctor appealed to his professional morality code, which states that he did not need to inform the patient in order to avoid harming him by giving him unnecessary anxiety over the procedure, the doctor still had a common morality obligation to inform the patient that the risk of death was on the table. In my view, the doctor has violated common morality, even though he adhered to his professional morality.
The second major reason that the doctor’s lack of action is unjustifiable is that he clearly violated the patient’s autonomy. According to Beauchamp and Childress, “At a minimum, personal autonomy encompasses self-rule that is free from both controlling interference by others and limitations that prevent meaningful choice, such as inadequate understanding” (Beauchamp and Childress 101). The doctor has clearly violated every part of this definition. First, interfered in the patient’s decision-making by withholding information about the risk of death. Since information was withheld, it cannot be said that the patient had adequate understanding to consent to the procedure, as he had no knowledge of the full scope of the risks associated with the procedure. Beauchamp and Childress go on to write that “the autonomous individual acts freely in accordance with a self-chosen plan” (Beauchamp and Childress 101). While the doctor can say that he respected the patient’s autonomy by giving him the option to opt out of the procedure, he really did not. If I was in the patient’s position, and the doctor told me that there was a chance that the procedure in question could kill me, then I would very seriously reconsider undergoing that procedure.
This case reminds me of a similar situation that I found myself in a few years ago. When I was in high school, I had really bad acne, and my dermatologist prescribed a medication for me. I took this medication for several months, and it did little to alleviate my acne. A few weeks after stopping the medication, I remember talking to my mom, who told me that the medication I was on had a potential side effect of causing my eyes to become filled with fluid that could have impaired my vision. Of course, I was quite upset that the dermatologist had not told me this. Just like the patient in this case, I felt like my autonomy had been violated in a sense.
Bibliography
Beauchamp, Tom L., and James F. Childress. Principles of Biomedical Ethics. 7th ed. New York: Oxford University Press, 2013. Print.
Thomas, John E, Wilfrid J Waluchow, and Elisabeth Gedge. Well and Good: A Case Study Approach to Health Care Ethics. N.p., 2014. Print.
I agree entirely that out of the spirit of the common morality, the physician should have disclosed all the risks to the patient. In light of the statistics that “over 5,000 angiograms had been done there over a decade without a single fatality,” (Thomas, Waluchow, and Gedge 301) it is evident that the physician has become desensitized to the risk of death from this procedure. The concept of desensitization in the world of medicine was discussed greatly in my sociology class last semester. In one of our readings, “The World of the Hospital”, the roles of nurses and physicians were discussed and how in order for them to survive in their careers without their emotions getting the better of them, they need to standardize and become desensitized to death (Chambliss). Thus, in this case, the physician may have avoided mentioning this risk of death as a means of remaining desensitized, but still abided by the obligation of respecting autonomy since the patient was given the option of opting out of the procedure completely.
Work Cited:
Chambliss, Daniel F. “The World of the Hospital,” Down to Earth Sociology. 1996.
Thomas, John E., Wilfrid J. Waluchow, and Elisabeth Gedge. Well and Good: Case Studies in Biomedical Ethics. Ontario: Broadview Press, 1987.
Hi guys,
Like both of you I believe that out of respect and an obligation to the common morality the physician should have disclosed all of the risks to the patient. The one thing that I wanted to emphasize is that the Dr. viewed angiograms as a routine procedure. While it is true that angiograms are successful in at leas 98% of patients, the risk of ensuing strokes, heart attacks, a decrease in cognitive function, etc. have all been reported as effects of angiograms (Brom). Last semester, my QTM professor organized a poll asking students to indicate at what percentage of risking of contracting breast cancer would they commit to chemotherapy (i.e. would you commit at 5%? 10?, etc.). The data revealed that students would go through invasive and life threatening cancer treatments to prevent death by cancer. I think that data such as this shows that people will go great lengths to save themselves and the ones they love, providing further reasoning why it is imperative that the patient and his family is informed of all surgical risks, prior to the operation.
Brom, Dr. Bernard. “Angiograms, Stents and Bypasses: Do They save Lives?” Angiograms, Stents and Bypasses: Do They save Lives? N.p., n.d. Web. 31 Jan. 2017.
I agree that the doctor had a responsibility to inform the patient about the risk, and I’ll extrapolate on what I believe to be the ethical duties of the physician in this situation. The angiogram is an example of how low risk does not equate with zero risk. However, it can be difficult to have something be considered truly zero risk in medicine. Thus, informing patients about risk then becomes a question of how to accurately represent the risk of procedure, especially in comparison to other available medical diagnostic procedures. If the risks are routinely overestimated to the patients, there is the concern that such warnings are no longer trusted as valid and become disregarded by the patients. Instead, risk factors should be assigned to specific side effects, as the risk of developing an infection from an angiogram is likely higher than risk of death. Without this, it’s hard for patients to be fully informed before they consent. People’s decisions aren’t solely governed by their perception of risk of death — there are many other factors that could be included in this decision. The same idea can be applied to learning about the specific risks associated with general anesthesia, which was required for the procedure. This can also help the patient make a decision that weighs the cumulative risks presented by anesthesia and invasive cardiology procedures.
When making decisions regarding diagnostic procedures, it should be the role of the physician to help the patient determine the best and safest method. Though a cardiologist and anesthesiologist may have reservations about referring a patient to a radiologist for non-invasive, lower-risk diagnostic procedures, the physician’s moral and ethical obligation is to ensure their patient receives the best and safest treatment — not maximizing their hospital or practice’s insurance reimbursements. Computed tomography coronary angiography, which doesn’t use anesthesia or invasive surgical procedures, provides higher-resolution imaging of the coronary artery than the invasive method (CT coronary angiogram). This should have been presented as an option for the patient to consider. It is the physician’s responsibility to inform their patient about the best possible options and equivalent risks for diagnostic procedures, and not doing so should be viewed as a mistake in medical judgment, resulting in misinformed consent.
CT coronary angiogram, accessed 4 Feb 2017, http://www.mayoclinic.org/tests-procedures/ct-angiogram/basics/why-its-done/prc-20014596