In this particular case, a moral dilemma has emerged due to a physician’s inability to provide information regarding the risk of a medical procedure. Although the probability of death was low, the patient ultimately died from the procedure. The physician was reluctant to provide the proper information, as the patient would experience unnecessary fear from a low-risk, life-saving procedure. This raises an intriguing question: was the physician acting in an ethical manner by withholding information concerning the remote risk of the procedure?
There are two ethical principals to consider and balance in this case. The first ethical principal is autonomy—the norm of respecting and supporting independent decisions (Beauchamp and Childress 13). In this case, the patient was not fully informed about the risks of the procedure. Therefore, the physician undermined the patient’s autonomy. The second ethical principal to consider is beneficence—a set of norms pertaining to relieving, lessening, or preventing harm and providing benefits (Beauchamp and Childress 13). The physician wanted to lessen the burden of fear, while providing adequate treatment for the patient’s heart disease. Essentially, the physician was acting in a paternalistic manner, as he justified his actions by preventing harm to the patient whose preferences or actions were overridden (Beauchamp and Childress 215).
It is imperative to consider both sides of the ethical dilemma in order to reach a sound conclusion. First, one must evaluate the role of beneficence within this case. The physician did not want to place an unnecessary burden of fear on the patient by informing him of the rare, remote risk of death. In fact, a strong focus on exhaustive information about low health risks may harm the patient (Palmboom et al.). The patient can be overloaded with a plethora of information that can impair, rather than facilitate understanding and decision-making (Epstein et al.). This cognitive overload can be exacerbated by the patient already experiencing emotional and physical distress due to the nature of their illness. Therefore, it can be argued the physician acted in an ethical manner by restricting the patient’s access to information—however, it is important to balance beneficence with autonomy to successfully resolve this ethical dilemma.
In regards to autonomy, the patient was unable to make an informed decision, as the physician did not fully disclose the risks of the angiogram. As the physician has highly specialized knowledge that the patient lacks, the physician had a duty to relay the risk and possibility of death. However, the physician acted on the patient’s behalf in a manner that undermined the patient’s autonomy. The doctor should have acted as an advisor, rather than the sole decision maker. The physician should “disclose as much information about the risks and benefits that the patient becomes sufficiently informed to participate in shared decision-making” (Murray).
Although it is unclear whether or not the patient would be alive if informed, the physician neglected his duty to respect the patient’s autonomy. The physician declared assumptions concerning the patient, stating that he was a “reasonable man, and most reasonable people choose the angiogram” (Thomas et al. 301). However, the patient was not granted the decision to make an informed choice. The physician has a duty to inform, despite the potential emotional risk that may emerge. The patient should be informed of all risks, along with the associated probability of occurrence. Essentially, the physician should be willing to negotiate with the patient in order to reach the best option for treatment, while considering the patient’s interests.
In this particular case, the physician’s blatant violation of autonomy brands the doctor’s actions as unethical. After balancing both autonomy and beneficence, the consequences of violating autonomy severely hinder the doctor-patient relationship in a detrimental manner. Therefore, the physician should have disclosed all information in this case.
REFERENCES:
Beauchamp, Tom L., and James F. Childress. Principles of Biomedical Ethics. New York: Oxford UP, 2001. Print.
Epstein, Ronald M., David N. Korones, and Timothy E. Quill. “Withholding Information from Patients — When Less Is More.” The New England Journal of Medicine (2010): n. pag. 4 Feb. 2010. Web. 27 Jan. 2017.
Palmboom, G. G., D. L. Willems, N. B A T Janssen, and J C J M De Haes. “Doctor’s Views on Disclosing or Withholding Information on Low Risks of Complication.” Journal of Medical Ethics. BMJ Group, Feb. 2007. Web. 27 Jan. 2017.
Thomas, John E., Wilfrid J. Waluchow, and Elisabeth Gedge. Well And Good: A Case Study Approach to Health Care Ethics. N.p.: Broadview, 2014. Print.
Murray, Bryan. “Informed Consent: What Must a Physician Disclose to a Patient?” AMA Journal of Ethics (2012): n. pag. Web.
Hi Marianna,
After reading this case, I too believed that the son had a valid claim against the physician. If there was a possibility of death, it should have been at least mentioned to the patient before he was able to consent to the angiogram. The son argued that “patients have a right to be given full information about any procedure to which they are subjected” (Thomas et. al 301). While I do believe that the physician should have disclosed the risks to the patient, I am not sure I completely agree with the son’s argument. There are many complex procedures that have high risks, but there are also many simple procedures that although technically have the potential to be fatal, the odds are far from likely.
For example, wisdom teeth removal is a very common dental procedure. Patients have the option of undergoing general anesthesia, causing them to slip unconscious throughout the procedure while being monitored by an anesthesiologist. Although this is a fairly routine procedure, there is always the possibility that something could go wrong. The American Association for Oral and Maxillofacial Surgeons stated that “the risk of death or brain injury in patients undergoing anesthesia during oral surgery is 1 out of 365,000” (Carroll). Although these odds are very unlikely, should they still be disclosed to the patient undergoing the surgery? If a patient is told that there was a 1 in 365,000 chance of the procedure ending in fatality, would it affect their decision on whether to go through with the surgery?
My question for you is do you think that regardless of how miniscule the probability is, any patient undergoing a procedure should be informed of all of the potential risks and corresponding probabilities? Is it enough to tell a patient that as with most procedures, there is a potential risk factor for death or other injures, or must each specific risk factor be laid out for the patient? Beauchamp and Childress mention a few standards of disclosure that are conflicting in the present case. According to the professional practice standard, it is up to the discretion of the physician to decide what information is or is not shared with the patient. However an issue with this stance is that often it’s “questionable whether many physicians have developed the skills to determine the information that serves their patients’ best interests” which is a main argument the son has against the physician (Beauchamp and Childress 126). However, there is also the reasonable person standard that bases judgment of disclosure on what a hypothetical reasonable person would deem necessary to disclose. This standard also presents obvious drawbacks, specifically that there is not a defined set of standards attached to “reasonable person” (Beauchamp and Childress 126). According to the physician in the case, he was following what he believed to be the latter standard of disclosure; however the son did not believe this reason argument to be valid.
Ultimately I do agree with your stance on this case; however I am curious how your stance shifts in relation to the standards of disclosure mentioned by Beauchamp and Childress and as the probability of risk/fatalities continues to decrease.
Beauchamp, Tom L., and James F. Childress. Principles of Biomedical Ethics. New York: Oxford UP, 2001. Print
Carroll, Linda. “Teen Dies after ‘routine’ Wisdom Tooth Surgery.” TODAY.com. TODAY, 06 Apr. 2012. Web. 03 Feb. 2017.
Thomas, John E., Wilfrid J. Waluchow, and Elisabeth Gedge. Well And Good: A Case Study Approach to Health Care Ethics. N.p.: Broadview, 2014. Print