The question presented by Case 10.3 “should patients be informed of remote risks of procedures” seems to appeal to the “obvious” answer: yes, patients should be informed. The elements of the situation, however, are not so simple. I would like to consider the points: (1) risk of death and (2) full disclosure and trust.
What poses risks of death?
Many daily activities and interactions are likely to have some “remote risk of death” (Thomas, 300). There are common medical procedures that can cause death, things in your household that can kill you and your daily choices such as diet and exercise can lead to fatal chronic diseases. To name a few: walking, drinking alcohol, smoking cigarettes, taking the stairs, choking, getting bit by a dog, vehicular accidents, and exposure to forces of nature. According to Medical News Today, the top 10 reasons for death in America are heart disease, cancer, chronic respiratory diseases, unintentional injuries/accidents, stroke, Alzheimers, diabetes, influenza and pneumonia, kidney disease and suicide. There is even a show called 1000 Way to Die, which narrates silly, yet real, causes of death. So, what poses risks of death? Pretty much anything and everything.
Is there such thing as full disclosure?
What is the practicality of full disclosure? Realistically, is it feasible to truly explain to patient(s) a procedure or treatment to a level of comprehension comparable to the comprehension of a medical professional, who has dedicated years to studying and understanding these procedures/treatments? The complexity of health and medicine is so immense and great; this is a reason why within medical professions there are many different specializations. It is not feasible to expect one person to know everything. The act of going to professionals and seeking health care requires an automatic certain level of trust. We trust healthcare workers to act in the patient’s best interest, take care of our loved ones, fight infectious diseases, and “save” patients. We rely on these people with specialized profession because they know and understand their role better than those with less knowledge in their field of study.
In the case of Joe and the anesthesiologist, I believe the anesthesiologist did give full disclosure. Precondition threshold elements of competence and voluntariness are fulfilled, and consent elements of decision and authorization are also fulfilled. The only division under debate would be information elements including elements of disclosure and understanding. Yes, “patients have a right to be given full information about any procedure to which they are subjected,” (Thomas, 301) and yes, healthcare workers are “obligated to disclose a core set of information” (Beauchamp 125). But, the key word is CORE. In the case of Joe, death was not a CORE part of information. I disagree with Joe’s son that the anesthesiologist “show[ed] lack of respect for patients as persons” (Thomas, 301). Healthcare workers such as the anesthesiologist do their best to inform patients while “consider[ing] the burden of fear and distress placed on patients” (Thomas, 310). Restaurants do not warn customers the risk of choking and dying before they order. Car dealerships do not give statistics of vehicular death before selling you a car. The anesthesiologist does not overwhelm patients by listing every bullet point of information about a procedure. Plans, unfortunately, do not always proceed as planned, and unexpected events cannot always be anticipated.
So the big question: who is right—Joe’s son or the anesthesiologist? I wouldn’t go so far as to say one party or the other is “right”, but rather, the anesthesiologist is not in the wrong.
Questions (for us) to consider: would you rather be imposed with burden of fear or remain blissfully ignorant? Have you ever withheld information from someone else? Is Joe’s son merely looking for someone to blame in his mourning and sadness? How can healthcare professionals, patients, and their families better communicate with more compassion?
Citations:
Beauchamp, Tom L., and James F. Childress. Principles of Biomedical Ethics. 7th ed. New York, NY: Oxford UP, 2001. Print.
“Danger of Death!” The Economist. The Economist Newspaper, 01 Sept. 2014. Web. 29 Jan. 2017.
Nichols, Hannah. “The Top 10 Leading Causes of Death in the US.” Medical News Today. MediLexicon International, 21 Sept. 2015. Web. 29 Jan. 2017.
Thomas, John E., and Wilfrid J. Waluchow. Well and Good: Case Studies in Biomedical Ethics. Peterborough: Broadview, 1987. Print.
Hi Pamela, good post! I agree with you on how we can’t possibly list of all the possible effects of a medical procedure, of dining in a restaurant, or even buying a car. Perhaps I’m a grim person, but there will always seem to be a possibility that these activities might have results that are queer to their supposed intent. I wonder though, to defend Joe’s son, whether his anger is directed to the fact that death (no matter how minute) seems to have the possibility of death as an integral procedure of the angiogram. Perhaps one example is: would you purchase a car if you found out that 7 out of 10,000 of these cars had killed babies while being in it because of the cars faulty combustion system that led it sometimes to produce a higher than usual carbon monoxide output? You might purchase the car based on your own calculation of the risk and decision, but perhaps you would feel obliged to know about this fact prior to the purchase, rather than not knowing about it?
Hello Pamela! I agreed with your argument considering the possibility of life-threatening situations being all around us. We roll the dice every day, not knowing whether it will be our last. Nevertheless, the last comment brought up a good point. Personally, I would rather know all the risks associated with anything, from a medical procedure to buying a car, no matter how minimal. Whether the chance exists for a situation to go awry is enough to make people take extra precautions to think about their decisions.
However, I disagree with the idea that the doctor is not necessarily in the wrong. Doctors have a responsibility to disclose all information about a procedure to a patient, even when the survival rate is extremely high. If he failed to disclose this information, he has not allowed his patient the full privilege of voluntary consent, disregarding the patient’s right to autonomy.
Hello Pamela!
Thank you for a great post. I enjoyed the points you brought up regarding how much we should seek to know and how much risk we are subject to every day just by being alive. In this specific case, however, I believe that the risk of death should have been more emphasized for the procedure as in all medical procedures involving general anesthesia. Even though the risks of anything happening to Joe were incredibly small, we are unaware of Joe’s level of education and knowledge regarding the consequences of medical procedures. What if he had never had a need to learn about anesthesia before this preventative test? I understand that this brings up the question of how we test for his level of education, but it is a doctor’s duty to effectively communicate with a patient and gain a full understanding of him or her as a person (Ha and Longnecker). Joe’s son may be looking for an outlet on which to place his grief, but he seems to be in a logical state of mind when he admits that his father’s death wasn’t the direct fault of the doctor and requests better doctor-patient communication. Better doctor-patient communication and understanding not only builds a trusting two-way relationship, but gives the healthcare institution more credibility as a whole. At what point do we assume that a patient is knowledgeable of medical procedures and fully understands them and their implications, and how do we assess their knowledge?
Ha, Jennifer Fong, and Nancy Longnecker. “Doctor-Patient Communication: A Review.” The Ochsner Journal. The Academic Division of Ochsner Clinic Foundation, 2010. Web. 06 Feb. 2017.
Hello Pamela,
Thank you for such an interesting post! I agree with your statement that the act of seeking health care from medical professionals requires trust; we trust healthcare workers to act in the patient’s best interest.
Therefore, from time to time, there become values that are more important than the truth. When this occurs, the role of telling the truth is trumped, or over-ridden by a temporarily more important principle. The ultimate value in all instances is the survival of the community or the well-being of the individual. Does this mean for paternalistic reasons, without the person’s consent, the right to the truth can be shunted aside? The truth in a relationship responds to a “multivariate complexity of values, the context for which helps determine which values in the relationship should predominate” (Thomasma 155-156).
The only values that can trump the truth, however, are recipient survival, community survival, and the ability to absorb the full impact of truth at a particular time. This is only true under certain limited conditions because respect for person is a foundational value in all healthcare and professional relationships (Thomasma 155). That being said, I agree with Gisell in suggesting that doctors have a responsibility to disclose all information about a procedure to a patient, even when the survival rate is extremely high. In this case, recipient survival is not severely impacted by disclosure of procedural information, and truth-telling is “a right, a utility, and a kindness” (Thomasma 155).
Works Cited
Thomasma, David C. “Telling the Truth to Patients: A Clinical Ethics Exploration.” Bioethics: Principles, Issues, and Cases. New York: Oxford University Press, 2010. Print.
Hi Pamela,
I completely agree with your post. Full disclosure in real life is very hard to achieve. It’s nearly impossible to explain all the possibilities of a procedure or all the side effects of a treatment plan. Additionally, even if a doctor tries as much as he or she can to give full disclosure of a situation, he may explain too much and scare the patient away from a procedure that could actually be helpful. If you’ve ever heard a commercial about a medication on TV, I’m sure you would understand what I’m saying. When I hear side effects such as stroke, seizure, and death, I always wonder if it’s really worth taking the medication to relieve a disease that doesn’t have side effects as severe. However, in reality, the chances of having the extreme symptoms mentioned above are so minuscule that the vast majority of these patients never experience them. Maybe, if they didn’t tell patients of these side effects, more patients would be willing to take the medication, and they would get the help they need (but this will never happen, or course, because of lawsuits).
This video is a perfect representation of the commercials I was talking about: https://www.youtube.com/watch?v=25fGWKZFLIY