Dr. Anita Ho’s article, “Relational autonomy or undue pressure? Family’s role in medical decision-making,” urges physicians and healthcare professionals to promote understanding and support between patients and their families regarding serious medical decisions.  Some see a family’s influence as a violation of a competent individual’s ability to make an autonomous choice about their health, and some see it as irresponsible on behalf of the doctor to allow a family to do so.  I would argue, however, that a family’s presence and influence in a patient’s decision is an important if not critical aspect of their own autonomy and that it should not be viewed always as a detrimental aspect to the decision-process, but a helpful one.

In her article, Dr. Ho states “Contemporary medicine has inadvertently reduced many patients with full histories and relational identities to diseased body parts and medical jargons” (Ho 130) to introduce the impact that advancing medical care has on a patient’s experience.  While advances in technology and more complex procedures are fantastic and life-saving, at times a patient feels small and helpless in the process.  If doctors neglect to fully explain situations and terms to patients, there is a risk of manipulation or detachment of the patient from the issue at hand.  The presence of a family’s questions and opinions in cases like these, as Ho mentions, can reduce confusion and allow the patient a sense of security.  A physician must certainly balance a family’s opinions as well as those of the patient on a case-by-case basis.

A family can sometimes aid in advising what professionals believe is medically best for the patient, but can also provide a patient assurance in what medical professionals perceive as the medically wrong decision.  In the W&G Case 3.2 concerning Simon and the administration of electroconvulsive shock therapy, Simon’s son was present and supported his father’s decision to not undergo the treatment.  There are other aspects of autonomy and consent present in this case, but in the familial sense, Simon’s son was present, listened to medical advice, and supported Simon’s decision.  The support Simon’s son offered did not necessarily sway Simon’s decision but still provided influence in it.

In an article by Dr. Laura Sedig published by the AMA Journal of Ethics, it is argued that “Focusing on the strict definition of autonomy and failing to recognize an individual as part of a family leads to an incomplete understanding of decision making for informed consent” (AMA Journal of Ethics).  Neglecting to involve a family in a serious medical decision does just that – creates a platform of misunderstanding and a risk of uninformed consent on behalf of the patient.  A holistic approach to medicine does not just include the physiological or mental components of a case, but the entire picture.  The impact of a patient’s relationships and understanding are paramount in ensuring the best medical decision is made.  Families’ opinions truly can influence a patient to the point where they completely change their mind about what they want.   A concept of autonomy is that “beliefs and choices shift over time,” (Beauchamp and Childress 113), so is ignoring a family’s ability to do this a risk to a patient’s own autonomy?

Works Cited

Beauchamp, Tom L., and James F. Childress. Principles of Biomedical Ethics. New York:  Oxford UP, 2009, 2013. Print.

Ho, Anita. “Relational Autonomy Or Undue Pressure? Family’S Role In Medical Decision-Making.” Scandinavian Journal Of Caring Sciences 22.1 (2008): 128-135. Psychology and Behavioral Sciences Collection. Web. 12 Feb. 2017.

Sedig, Laura, MD. “What’s the Role of Autonomy in Patient- and Family-Centered Care When Patients and Family Members Don’t Agree?, Jan 16 – AMA Journal of Ethics (formerly Virtual Mentor).” AMA Journal of Ethics. American Medical Association, 2016. Web. 12 Feb. 2017. <http://journalofethics.ama-assn.org/2016/01/ecas2-1601.html>.

Thomas, John, Wilfrid J. Waluchow, and Elisabeth Gedge. “Case 3.2: Non-Consensual  Electroconvulsive Shock Therapy.” Well and Good: A Case Study Approach to Health Care Ethics. Peterborough, Ontario: Broadview, 2014. 124-31. Print.

Image Credit

Peter C. Vey/The New Yorker Collection/The Cartoon Bank

(from: http://blogs.hospitalmedicine.org/Blog/the-return-of-the-death-panel/)

Voluntariness falls under both the informed consent and the autonomous actions category in bioethics making it an important factor in a lot of medical practices; specifically, human medical research. Here we define voluntariness according The Nuremberg Code which states that a research subject “should be so situated as to be able to exercise free power of choice, without the intervention of any element of force, fraud, deceit, duress, over-reaching, or other ulterior form of constraint or coercion” (Beauchamp, 137-138). In general, this is a very lengthy and detailed definition the term, but it brings up some very interesting points about a case we have previously studied, specifically about the voluntariness of consent.

In the case of “Research Involving Alzheimer’s Patients” we are faced with a director of a nursing home for Alzheimer’s patients who is asked to allow her residents to participate in study to test a new drug that promises to reduce the onset of the disease in subjects. After a swift denial of the researcher’s offer, we are asked to evaluate the director’s decision and conclude whether or not this was a violation of the patient’s autonomy. Initially, I noticed that the general consensus amongst our class was that the patients should be able to make their own decision and if a patient lacked the mental capacity to do so, the closest relative who knew him/her best could make the decision on their behalf. After analyzing the definition of voluntariness, though, this decision our class made fell short on the side of allowing a family member to make the call. While these terms could be interpreted differently, allowing another person to make a decision for a less than coherent individual could fall under many of the listed “intervention” elements, opposing the idea of voluntariness in medical research.

Voluntariness is a hard subject to study because no one research subject is the same. “Voluntariness of consent has been more resistant to investigation, leaving policy-makers with little guidance for their efforts to insure that prospective research subjects are able to exercise meaningful choice about whether to participate in research” (Applebaum et.al, 2009). Things such as the case we discusses above are reasons why voluntariness of consent can become incredibly complicated especially when it comes to policy-making. When you have to take a look at mental capacity of a subject and analyze every element given in the formal definition, you find that is it hard to have a concrete idea of what exactly voluntariness is in a particular situation. In the case with the Alzheimer’s patients, I believe that voluntariness was violated in the patients who are of the coherence to make a decision about his/her participation, but I do not think that it was violated in the cases of patients who did not have full mental capacity as that could have crossed the line into force, over-reaching, etc. Essentially, voluntariness has its flaws as an element of informed consent and autonomous action, but it is important to take into account especially when considering human subjects for a research proposal.

Works Cited:

Applebaum, Paul S., Charles W. Lidz, and Robert Klitzman. “Voluntariness of Consent to Research: A Preliminary Empirical Investigation.” IRB: Ethics and Human Research 31.6 (2009). The Hastings Center

Beauchamp, Tom L., and James F. Childress. Principles of Biomedical Ethics. New York, NY: Oxford UP, 2001. Print.

Thomas, John E, et al. “Case 3.1: Research Involving Alzheimer’s Patients.” Well and Good: Case Studies in Biomedical Ethics, Broadview P, 1987.

Dilemma:  

Stephen Dawson is a severely mentally challenged seven year old kid that requires a simple yet critical surgery. His parents give their consent for the surgery at first, yet after a day, they have a change of heart and decide to refrain from the surgery in an effort to end his suffering. After learning this, the superintendent of family and child services decided to take the case to court where custody was granted to the parents. Following a petition to the case, custody was then temporarily granted back the superintendent where the surgery was performed. Was this right? Who should decide on Stephen’s life?

Discussion:

I tend to agree with Justice Mckenzie in granting the custody of Stephen to the superintendent and promoting the life-preserving surgery. From my perspective, the parent’s decision to not consent for the surgery seems to be an effort to ease their suffering, not Stephens. Stephen is seven years old and only remained at home with an over stressed family attempting to take care of him for approximately two years. After which, he went to Sunny Hill, is a place equipped for caring for disabled children, only to be moved a year later to a foster home where the parents were told he was taking up space. He remained at that foster home for three years, until he was returned to Sunny Hill. So Stephen has spent nearly half his life in places where he was seen as a stagnant burden which may have had a negative impact on Stephen’s quality of life, yet there is some sunshine in this story. During his time at Sunny Hill, they experience a new side of Stephen that shows potential by responding to certain stimuli such as smiling at people, clapping his hands, and turning on a fan. Additionally, it is completely possible that the perspective of the parents in regard to the happiness of Stephen’s life does not accurately match Stephen’s perspective of happiness as well. Since his brain functions differently, perhaps his idea of happiness is different from ours as well. The two perspectives of Stephen paint two vastly different pictures of him. On one hand, we have a non-responsive child involuntarily clinging to life, and on the other hand, we have a child that shows promise and exhibits happiness.

I tend to think these conflicting perspectives are due to the conflicting environments Stephen was subjected to during his life. During his time in the foster home, his care was noted by the parents as sub par. In addition to this, his parents themselves complained about being unable to provide proper care for Stephen which was their reasoning for placing him under the care of Sunny Hill initially. While I do not question the parent’s values for initially placing him under someone else’s care, I do think that leaving him in the foster home with low quality care was a poor choice. The case does not list any financial drawbacks of Sunny Hill to explain Stephen’s presence in the foster home, so I wonder why he was not placed back into Sunny Hill if he seemed to have good experiences there. Nevertheless, a facility fully equipped to care for mentally challenged children is a vastly superior environment for growth compared to a overstressed home or an apathetic foster home. If Stephen actually exhibits qualities of happiness at Sunny Hill, then his care should continue under their supervision. 

Works Cited:

1. Thomas, John E, et al. “Case 6.4 Stephen Dawson: Should Severely Mentally Challenged Patients Be Treated?” Well and Good: A Case Study Approach to Health Care Ethics, 4th ed., Broadview P, 2014, pp. 229-235.

I believe that Justice McKenzie made the correct decision when he “ordered that temporary custody [of Stephen Dawson] be assigned to the Superintendent of Family and Child Services and that the operation to replace the shunt be performed” (Gedge, Thomas, and Waluchow). Stephen’s case raises several contested topics regarding autonomy and the rights of disabled individuals.

In general, when a patient is found incompetent, their family is responsible for serving as the decision-maker for the patient because they are most likely to know what would be in the best interest of the patient. However, that is not necessarily the case when the family has not been in contact with the patient in question for an extended period of time. In those situations, should someone who is closer to the patient assume the decision-making rights of the family in order to make sure the patient’s best interests are respected? Physicians have the authority to “choose a surrogate for a patient with limited competence or to make decisions for a totally incompetent patient. The surrogate may be a relative, close friend, physician who knows the patient well, or someone provided by the hospital or government” (“Medical Decision Making for the Incompetent Patient”). I believe that Stephen’s physician or primary caregivers are appropriate surrogates and should be able to override the family’s decision to decline the surgery. Stephen has lived away from his family for an extended period of time and, as a result, they no longer know what is in his best interest. On the other hand, Stephen’s physician or primary caregivers have been working with Stephen for years and know more about his current state.

Another question presented in this case addresses when it is justified to withhold treatment for an incompetent patient. In this case, the specific question is whether surgery will improve  Stephen’s quality of life or make it more burdensome for himself and those who care for him. To answer this question, I would speak to Stephen’s primary caregivers to gather information pertaining to his general happiness and progress over the years. After hearing that “the professionals at Sunny Hill who have worked with Stephen over the years found him to be ‘a happy little fellow despite his handicaps,’” I would declare that the surgery is in no way extraordinary, and instead necessary (Gedge, Thomas, and Waluchow). While the surgery will not fix Stephen’s handicaps, it will help him to continue to live a happy life. I think that it is Stephen’s right to life. In no way does death seem like the better alternative to surgery in this case.

I think the hardest aspect of cases dealing with incompetent, mentally disabled individuals is determining when they are suffering and in pain. For example, in case 6.3, Mr. Latimer deliberately killed his daughter in an effort to “relieve his daughter’s continued and inevitable suffering” (Gedge, Thomas, and Waluchow). How did Mr. Latimer know that his daughter was suffering? In general, those who are incompetent and mentally disabled are unable to formulate sentences or demonstrate their feelings. As a result, I think it is absurd for Mr. Latimer or Stephen’s parents to claim that their children should die to relieve their suffering. While I do not have a solution to ascertain whether incompetent and mentally disabled patients are suffering, I think it is a violation of their autonomy for others to decide on their behalf if they should die to end their suffering.

Works Cited:

“Medical Decision Making for the Incompetent Patient.” Health Progress (Saint Louis, Mo.).U.S. National Library of Medicine, n.d. Web. 10 Feb. 2017.
Thomas, John E., Wilfrid J. Waluchow, and Elisabeth Gedge. Well and Good: A Case Study Approach to Health Care Ethics. Peterborough, Ontario: Broadview, 2014. Print.

In the case of Stephen Dawson, I agree that Justice Lloyd McKenzie of the Supreme Court was correct in assigning the Superintendent of Family and Child Services the responsibility of making the medical decisions for Stephen. My reason for agreeing is based on the determination of quality of life.

The concept of quality of life can be interpreted in many different ways but overall, the term generates the idea that the patient should always be considered to have a standard of health, comfort, and happiness. With this in mind, according to the medical professionals at the Sunny Hill facility, Stephen seemed to show a quality of life since he engaged with others through laughter as well as demonstrated potential for advancement. Because Stephen has shown signs of quality of life, just a different interpretation of what is normally the case, then it should only be morally fair for Stephen to receive this surgery that way his personal quality of life has the chance to be prolonged.

At the same time, however, Stephen’s parents believe this should not be the case, and he “should be allowed to die with dignity rather than continue to endure a life of suffering,” (Thomas, Waluchow, and Gedge 231) which rejects the performance of the surgery. According to their wishes, it seems as though Stephen’s parents believe Stephen lacks a quality of life and should not continue living in this state. However, I believe though that this assumption is lacking in support since the parents are judging Stephen’s quality of life or rather lack of on the premise of what they knew to be true when they were caring for him and not of how he actually exists in his current state at Sunny Hill. Additionally, Stephen’s parents could also be adopting the idea of considering their own quality of life because as much as parents have unconditional love for their children, sometimes in dire situations such as this case, if Stephen were no longer alive, then that would ease the parents’ emotional burden. Yet, this idea of imposing what is best for the family’s life against the patient’s medical best interest is in a sense improper (Beauchamp and Childress).

Additionally, when dealing with the quality of life of disabled people whether mentally, physically, or both, it is often seen that the quality of life can sometimes in a unique way be more rewarding than that of a person without disabilities. When it comes to having disabilities, many times the smaller things that non-disabled people take for granted are noticed and more appreciated. This idea of a greater sense of quality of life is explained more in the BBC News Magazine article “A Point of View: Happiness and Disability,” which states that “sometimes, the part of life that is difficult brings other benefits, such as a sense of perspective or true value that people who lead easier lives can miss out on. If we always remembered this, perhaps we would turn out to be more accepting of disability and less prejudiced against disabled people.” Thus, even though Stephen’s medical state and legal state as a whole are very serious, complex as well as far from “normal,” there is some evidence that his quality of life that exists within Sunny Hill, even as small as it may be, provides something better than the alternative of death.

Work Cited:

“A Point of View: Happiness and Disability,” BBC News Magazine, http://www.bbc.com/news/magazine-27554754

Beauchamp, Tom L., and James F. Childress. Principles of Biomedical Ethics. New York, NY: Oxford University Press, 2001.

Thomas, John E., and Wilfrid J. Waluchow. Well and Good: Case Studies in Biomedical Ethics. Ontario: Broadview Press, 1987.

Dilemma: Stephen Dawson was premature and suffers from extensive brain damage and lowered mental and physical capacities due to meningitis. He cannot be left alone and his parents have described his life as being “painful and unhappy.” It was found that he needed an operation to repair a blockage in his brain shunt and without this operation, he would die. Should Stephen undergo the operation or should he be allowed to “die with dignity” and avoid future suffering according to his parent’s wishes?

Discussion:

This is a very conflicting case in my opinion; however, I believe that Stephen Dawson should be allowed to pass away as his quality of life is very low and his chances of ever improving or being able to live on his own without constant care are low as well.

In cases such as this one, I believe that Stephen’s present and future quality of life must be considered. While the case study states that he has not officially consented to refusing treatment, he is also not competent to do so. Because he is incompetent, it is fair for his parent’s, who have spent much time caring for him and observing the struggles he has had to undergo, to decide whether it is worth allowing him to undergo the operation. If it were an operation to help him gain some of his mental and physical capacities, then I would agree that the surgery should take place. However, this surgery does not hold that promise and would simply serve to “prolong a life inflicted with an incurable condition (Thomas, et al. 229-235).”

Simultaneously, this does bring up the issue of the value of the life of a disabled person. Do they not have rights as well? While this is a serious question, I believe that in this case, the value of Stephen’s is not being questioned or determined but simply his quality of life. Stephen would continue to live with great difficulty and would never achieve independence or be able to fully enjoy life. Involuntary passive euthanasia is appropriate in this case. This form of euthanasia occurs when the patient is unable to consent and life sustaining treatments are withheld (Nordqvist).” There are many reasons why passive euthanasia would be utilized. In this case, Stephen’s medical situation would progressively get worse and his “expected quality of life is so poor that life will be worse… than death (Garrard).” Stephen cannot feed himself and he has the capabilities of an eight-week-old infant according to the case study. I am not arguing that because of these disabilities, Stephen is not worth preserving; however, I do believe that it is within his best interests to not suffer any longer than he has to. The surgery would not cure him but would only serve to keep him alive. He would still have to face these challenges and most likely many more as he gets older.

Works Cited

Thomas, John E, et al. “Case 6.4 Stephen Dawson: Should Severely Mentally Challenged Patients Be Treated?” Well and Good: A Case Study Approach to Health Care Ethics, 4th ed., Broadview P, 2014, pp. 229-235.

Garrard E, Wilkinson S Passive Euthanasia Journal of Medical Ethics 2005;31:64-68.

Nordqvist, Christian. “Euthanasia and Assisted Suicide.” Medical News Today, 8 Apr. 2016, www.medicalnewstoday.com/articles/182951.php.

In October of 1973, Sam Shoeman was diagnosed with terminal cancer and given three months to live. Just after New Year’s, he passed away. However, an autopsy revealed that his original liver scan was faulty and his tumor was so small it couldn’t possibly have killed him. His doctor could not determine the cause of death stating “[Shoeman] didn’t die from cancer, but from believing he was dying of cancer” (Pilcher, 2009). Today, doctors routinely cite Shoeman as a victim of the nocebo effect.

We are all familiar with the placebo effect, as we discussed it in class today. A patient takes a pill — which could simply just be sugar — and somehow they feel better! However, Psychology Today describes the placebo’s equally powerful and far less understood evil twin: the nocebo effect, or the unintended consequences of negative thinking (Barber, 2012). The nocebo effect has the potential to disrupt how we communicate with our doctors while demonstrating the true power of the human mind.

In Latin, nocebo translates to “I will harm” (Merriam-Webster, 2017). But it’s true power doesn’t only lie in linguistics. A 2011 article in the journal of Neuropsychopharmacology defines the placebo effect as a positive reaction that stems from the suggestion of benefits. Conversely, the nocebo effect is a negative reaction that stems from the suggestion of harmful side effects (Benedetti, 2011). For example, at the University of California, participants had electrodes strapped onto their heads and were told that the electric current may cause severe headaches. Over 67% reported headaches; however, not a single volt of electricity was produced (Fox, 2012).

The fact that just mentioning negative symptoms can worsen a patient’s outcome challenges informed consent. Doctors are required to tell patients about all possible side effects of any treatment. But knowledge of the nocebo effect places physicians in an ethical dilemma, giving a whole new perspective to the old adage, “truth hurts.” In March of 2012, researchers at Harvard proposed a way to combat this ethical tug-of-war: contextualized informed consent (Wells, 2012). Dr. Colloca at the National Institutes of Health explains that when a doctor says “2% of subjects experienced this nasty side effect”, the patient will focus on the harm. But if the doctor says “98% of patients did not have that experience”, patients are less likely to experience the nocebo effect while still being informed (Berdik, 2012). In other words, the nocebo effect highlights the need for even more care when doctors and patients communicate.

While doctors may use their knowledge of the nocebo effect to alleviate pain, some may be more inclined to invoke the evil twin for less noble intentions. A 2011 article in Science Translational Medicine examines how the nocebo effect can intentionally induce pain. Participants were separated into 2 groups. Each was given a steady dosage of pain medication as heat was applied to their leg. Group 1 was told that the medication was starting. This knowledge doubled the positive effects of the medication. However, Group 2 was told mid-experiment that their medication had stopped and they may feel more pain (even though it didn’t actually stop). The nocebo effect was so strong that the group reported pain at the same level as a third group receiving no medication (Bingel, 2011). In other words, doctors used the nocebo effect to create pain that didn’t exist. Imagine this ability in the hands of interrogators bound by strict restrictions on physical harm. How might attitudes on torture shift if pain stems only from the mind of the victim?

In conclusion, the placebo effect (and now, the nocebo effect) present significant ethical questions surrounding the principles of respect for patient autonomy and nonmaleficence. Can we find a way to balance both of these principles? Comment with your thoughts!

REFERENCES

Pilcher, H. (2009). The science of voodoo: when mind attacks body. New Scientist.

Barber, N. (2012). Voodoo Death I. Psychology Today.

Merriam-Webster. (2017). Definition of nocebo. Merriam-Webster Dictionary. 

Benedetti, F.; et al. (2011). How Placebos Change the Patient’s Brain.

Fox, E. (2012). Rainy Brain, Sunny Brain: How to Retrain Your Brain to Overcome Pessimism.

Wells, R.; et al. (2012). To tell the truth, the whole truth, may do patients harm: the problem of the nocebo effect for informed consent. American Journal of Bioethics, 12(3), pp. 22-29.

Berdik, C. (2012). The nocebo effect: how health warnings make you sick. Boston Globe. 

Bingel, U. (2011). The effect of treatment expectation on drug efficacy. Science Translational Medicine, 3(70), pp. 70.

Background:

Amira’s family got into a car accident where her partner got a severe injury and were soon announced death. Her daughter was in light injury upon this incident. Amira was placed in the hospital’s trauma room, as she woke up and acquired immediate information about her family. Her health condition was critical and she had a big surgery to go through. The nurses were informed about Amira’s partner’s death and were hesitated to tell. They made the decision for Amira that, if Amira survived the surgery, she could learn the truth about her family tragedy in her recovering period.

Dilemma:

The Dilemma of this scenario was whether to announce the news or not. Most of the nurses insisted that under such condition, learning her partner’s death might severely threaten her own health well-being. As a nurse, one obligation is to make good health decision for the patient. It is important to implement actions which would help the patient survive. Many may claim that the patient might not show full comprehension to their own health status in emergency situation. So it might be the best idea to ask the medical professional to make the decision under those situations. In Amira’s cases, her vital signs are losing and one lung already collapsed. She is concerned about her family, and her health well-being might be the main goal from the nurse’s perspective.

A few other nurses stated that Amira deserved to get information as she acquired even in her endangered state.  Many may have claimed that she deserves to get information as she acquired. There have been researches done in the past that most patent would like to know the truth rather than white lie during the situation. In Amira’s situation, she acquired to learn about her family situation upon her wake up. This could further state the importance of her family’s well-being to her. She is concerned about her family situation like any other human beings, and she deserved to be informed of the real situation.

My decision:

Balancing both ends, I would choose to tell the patient about the truth for the sake of her well-being. There could be professional people handling the wording of the truth telling process to make it more acceptable. The truth could be hard for her to accept during the moment, but there could be professional health communicator facilitating the process who help the nurse know, when, whom, and how to tell the tragedy. The nurse could state by: “Your daughter is still waiting for you outside the emergency room, and there is a hardcore surgery you need to fight over.” By setting up faith and encouraging the patient, the truth could be told.

Another important reason is patient deserve to know the information they acquire. Even the best medical care team could make decisions for individuals. From professional’s perspective, their main objective is to cure and to save, but individual’s thoughts should play a stronger factor in their own decisions. Whatever happens, individual should get the information they acquire to know and make their own decision. Although people claimed that sometimes patient’s pain could not balance with their decision, the decision is still upon patient’s. “We don’t know what we don’t know.” As there are many circumstances going on in patient’s life, physicians should not make decisions thinking “it would be the best for patients.” We all wear different shoes in life, and only our own decisions could determine the road we are heading to.

Citation

RD Yeo, M., A. Moorhouse and P. Khan “Case 3: Emergency and Trauma Nurses: When to Give Bad News” Concepts and Cases in Nursing Ethics.

In medicine there’s often a debate about whether to tell a patient about a current situation, or to lie if it might be in their best interest. In the case about Amira, nurses were dealing with the moral conflict on whether to tell her that her partner, Casey, had died in the accident, or to wait until after the surgery. The moral dilemma that the nurses face is deciding between nonmaleficience and telling the patients the truth. On one hand, the nurses don’t want to do the patient any harm. By telling Amira that her spouse died, the nurses can weaken her health even more, potentially causing her death. When people learn of a sudden death of a loved one “they can experience symptoms of shock” which can affect mental state, blood pressure, or breathing (“Sudden Bereavement: Responses in the Early Weeks”). Because of her extremely fragile state, it may be detrimental to Amira’s health if the nurses were to tell her about her partner. As she has already lost a lot of blood, a drop in blood pressure because of the news of her partner could lead to her death. But, how do we know that Amira would react to the news in this manner, entering into a state of shock? Amira may take the news better than other patients—is it then obligatory for the nurses to tell Amira the news if they think she would handle it better?

On the other hand, many medical professionals find it obligatory to tell patients the whole truth, regardless of the outcome. One of the main jobs of a nurse is to build a good relationship with his or her patient in order to act as the patient advocate, advising them on procedures and making sure the patient’s best interest is in mind. A major key to establishing this relationship is building trust with the patients. If the nurse isn’t upfront with Amira from the beginning, how is Amira to trust the nurse in further discussions? Another concern the nurses had was that Amira “might die…without knowing the truth about Casey” (Yeo, 233). Though this isn’t really a concern for Amira’s well-being (if Amira dies, it won’t matter to her that she didn’t know), it’s a concern about the nurses and their own conscious, which should be considered when deciding on what to do.

Weighing both of these factors, the best decision for Amira would be to not tell her about Casey until after the surgery. One must also keep in mind the impact this decision has on their daughter: if there is any chance that not telling Amira at the present moment about Casey might increase her chances of surviving, then we shouldn’t tell Amira in hopes of giving Samantha a better chance of not being an orphan. Additionally, it’s not uncommon to withhold information. According to Thomas Smith, only “37% of terminally ill patients have explicit conversations with their doctor about the fact that they are going to die from their disease” (Schwartz). If it’s acceptable to not tell most terminally ill patients the inevitable, then it should be acceptable to not tell Amira about Casey, especially if it gives her a better chance of survival. Additionally, there are no benefits for telling Amira about her partner sooner rather than later. For example, there are benefits for telling terminally ill patients that their death is soon: they can write their wills, decide power of medical attorney, etc. But, if the nurses tell Amira about Casey, there is nothing she can do, because she’s currently fighting for her own life. Therefore, the best course of action is to tell Amira about Casey after she wakes up from surgery, and to remind her that Samantha is perfectly healthy and needs a mom.

Works Cited

Schwartz, Shelly K. “Is It Ever OK to Lie to Patients?” Physicians Practice, UBM

Medica, www.physicianspractice.com/difficult-patients/

it-ever-ok-lie-patients.

“Sudden Bereavement: Responses in the Early Weeks.” Sudden: Supporting People

after Sudden Death, Brake: The Road Safety Charity, www.suddendeath.org/

help-for-professionals/online-guidance/2-uncategorised/76-earlyweeks.

Accessed 31 Jan. 2017.

Yeo, Michael, et al. “Case 3: Emergency and Trauma Nurses: When to Give Bad

News.” Concepts and Cases in Nursing Ethics, 3rd ed., PDF ed., Broadview

Press, 2010.

In medicine, there are those who think a traditional approach is best. They believe that medical problems should be treated with proven medical treatments. However, within the past few decades, there has been an increase in the use of placebos, which are treatments with no supposed medical benefits, in attempts to provide aid to the patient. In the reading by Lichtenberg, there were several cases in which placebos were used with different results. I will be drawing from the cases presented in order to formulate a case for why placebos should be considered ethical in medicine.

One concern surrounding placebos is the issue of effectiveness. There are concerns that placebos should not be used, because they provide little to no medical benefit to the patient. This claim can be argued against in Case 3 of the Lichtenberg reading, where a woman was treated for depression using a placebo. “Although a placebo was not intended to be used, it had substantial benefits to the patient, to the point where discontinuing use of the placebo would be considered unethical, and may even harm the patient in bringing about symptoms of depression” (Lichtenberg 553).

Questions have also been asked about the morality of placebos. A general rule of placebos is that in order for them to work, the patient has to be deceived into believing the medicine that they are being treated with is conventional medicine and has a proven medical benefit. This is one area where placebos fall short, as their effect is largely unknown to researchers, and many trials are being done to study why placebos work (Feinberg, harvardmagazine.com). However, the claim of deception may vary from case to case, as there have been cases where placebos have been openly discussed. Although this may be seen as counterproductive to the use of placebos, disclosing that a treatment is a placebo may not necessarily diminish its effectiveness (Lichtenberg 552). In the case with the 42-year-old man who had a case of gastroenteritis, the husband and wife asked the doctor for a placebo, after the doctor had already expressed his opinion that the issue would resolve itself in a couple of days (Lichtenberg 552-553). In some cases, even if a physician states a treatment is unnecessary, that does not mean the patient will not want to receive it in hopes of a better recovery.

The effect of disclosing treatment methods to the patient was also tested in a study by Ted Kaptchuk of Harvard University. In a pilot study published in 2010, two groups of subject were studied: one group was given no treatment, and another group was told they would be receiving placebo pills and that the pills could potentially have healing effects (Feinberg, harvardmagazine.com). Although further research needs to be done, the study showed that the group given placebo pills had significant improvements over the group given no treatment whatsoever. This improvement was so significant, it rivaled the improvements of groups that had been given the actual drug in other studies (Feinberg, harvardmagazine.com).

Another claim raised against placebos is that they are not deemed to be true medicine. Several proponents of conventional medicine believe medicine is based on years of research and has a measured benefit when given to a patient. Placebos are different in the sense that they are given the label of alternative medicine, which consists of things such as pills, needles, and saline injections. Placebos also have difficulty proving they are effective from a scientific viewpoint. However, if the treatment is effective for an individual patient, why shouldn’t they be used? People go to the doctor in the hopes of being healed and alieved of their symptoms. If placebos can accomplish this, what’s wrong with that? Wouldn’t it be considered unethical not to use the placebo, if there was a possibility of treating the patient when other methods were ineffective?

Citation:

Feinberg, Cara. “The Placebo Phenomenon.” Harvard Magazine. N.p., 03 Mar. 2014. Web. 03 Feb. 2017.

Lichtenberg, P. “The Ethics of the Placebo in Clinical Practice.” Journal of Medical Ethics 30.6 (2004): 551-54. Web. 3 Feb. 2017.

Placebo Effect. Digital image. WordPress. N.p., n.d. Web. 4 Feb. 2017.