In these decades, informed consent has been a significant medical issue. People still aren’t sure what kinds of actions to take in some cases. For example, should doctors respect the patients or the patients autonomy? Also how much information should the doctors provide their patients? These situations are really hard to deal with because there are many barriers to informed consent such as patients’ and doctors’ attitudes, medical system, and the information given for the decision making. In the following example, it shows a recent article that deals with informed consent.
On February 2, 2014, there there was a news called “Donor’s death shatters family, stuns surgeons” (www.bostonglobe.com). Paul Hawks, who was 56 years old, decided to donate some parts of his liver to his brother-in-law Tim Wilson, who had liver cancer. However, Paul died during the liver transplant. So what exactly happened in this case? Did the doctors and the patients make the right decisions? In the article, it mentioned that Paul was considered an older donor and was also examined to have extra blood vessels and abnormalities on his electrocardiogram. However, these situations didn’t change the hospital’s transplant team’s decision on this transplant. Instead, they decided to continue this case, because they were confident since the team had never failed any transplant. Even though in this article the reader couldn’t tell if the doctors actually told Paul and his family about his age and some problems he had, it mentioned that “When the donor is a child, parent, spouse, or sibling, the recipient’s survival is more obviously paramount to them — and the donor’s acceptance of risk therefore more understandable.” It seemed to me that the doctors assumed that the patient’s choice was rational because Tim was his relative. Since the doctors were so confident of their past record, it showed that the doctors didn’t inform the information (consequences) well enough to the patients in order for the patients to make a right decision. As Robert M. Veatch had written, “But even understanding is not enough. Facts must be assembled to tell a story or to construct an argument which stands in the foreground of deliberation” (Holland pg 334). Therefore in this case, the doctors probably didn’t deliver the information in a more constructed way. The doctors should have directed the Paul to think more about the transplant and the side effects of it.
This case also raises other questions such as should the donor be able to know the recipients’s risk factors and that the recipient should know that donors have some health problems that might cause transplant failure. By disclosing these information, it allows the donors and recipients to make better judgment and decisions. However, this also leads to another situation, which is privacy. By protecting privacy, the donors and the recipients lack some information to make appropriate decision. Therefore in this case, should we care more about the privacy or the outcomes of the decision.
Kowalczyk, Liz. “Donor’s Death Shatters Family, Stuns Surgeons.” Metro. BostonGlobal, 02 Feb. 2014. Web. 02 Mar. 2014.
Your concern is valid regarding a need for comprehensive education system for organ donors. A Donor who decides to give part of his/her liver to one of the relatives has a right to be educated on complete information about the procedure so that he/she can make an informed decision. Patients have to be informed about potentially life-threatening medical complications associated with organ donations. Once patients are educated, they also have to understand that an unanticipated medical outcome is possible during any surgical procedure. Although, a huge number of living organ donations are successful, like any other surgical procedure, the risk of dying during organ donation is imminent. In her study, Dr. Elizabeth Pomfret, Chair of the Department of Transplantation and Hepatobiliary Diseases at Lahey Hospital & Medical Center in Burlington, Massachusetts, showed that out of total 71 centers that performed 11, 553 living donor liver transplantation, donor mortality was only 0.2%. Transplant success rates greatly depend on the hospitals as well. It is the patients’ responsibility to look into information such as how many transplants the selected hospital performs each year and how long has the hospital been doing transplants. As I am writing this post on 3/4/2014 at 9:56 AM, there are 15,722 waiting list candidates for liver transplant (http://optn.transplant.hrsa.gov/data/). I believe, we must improve the patient education process, but we also should not forget that 15,722 as of right now still need liver donors…
Choosing to donate an organ is a very difficult decision. Most patients are already aware of the risk of death for transplant procedures, but this risk is true of any surgical procedure. Something that can sway patients to consent to donating is informing them that the risk of death is very low. It seems that the physicians in this case did just that, but they failed to inform her and her husband that this data was just from the United States. They were unaware of the other deaths that occurred overseas. From a doctor’s perspective, they must keep in mind the best interests of both the donor and the recipient. Therefore, they should not sway the donor so that they can save one individual. Instead, they must inform both individuals of the risks in depth so that both of their safeties are not compromised. As a doctor you can only do so much too help a patient receive a transplant, and saving the recipient at the expense of the donor should not be even considered. As for the privacy issue, that should be up to the recipient and the donor about how much of their information that they want shared between one another. However, if withholding information of one puts the other in danger, then sharing that information should be up to the physician.
I think case was clearly an example of strong paternalism and physicians who view themselves as superior. Organ transplants are a gift from one patient to another patient. The physician is responsible for explaining the risks to both parties involved. Moreover, the patient who donating an organ or part of it should have a very clear picture and knowledge of all the information pertaining to their case and situation because they are electively undergoing a serious procedure whereas they are not gaining any health advantage.
I believe that the physicians assumed that Paul would want to try to save his brother-in-law no matter the cost to himself. While this maybe true, Paul was not given an alternative. The physicians do not know if Paul agreed because he did not believe that he would die from the surgery. If that was the case, he might have changed his mind. Furthermore, the lack of information did not allow Paul go into the surgery knowing of the possible risk and so he did not have the necessary information to get his affairs in order. I believe that the critical error was the assumptions that they doctors made.
Your case brings up an unique example that shows why informed consent is important. Generally we believe that being a donor for a relative is extremely important, and that it would provide great benefit not only for the donor but for the family as a whole. In a way, the donor is saving the family from experiencing hardship.
In your post you mention the importance of saving a relative, and that acting as a donor and the risks involved with it may be glossed over. The situation presented in the article reminded me of the book, “My Sister’s Keeper”. Even though the book brings in a lot more ethical questions than just informed consent (one of the characters was made to act as a continual organ donor for her sick sister), it focuses on the difficulties of acting as a donor for a family member. Part of the book’s plot focuses on how the donor, Anna, does not want to donate to her sister Kate. Kate has a form of leukemia which is why she needs a donor. The plot gets more complicated as the book continues, and does a great job showcasing the difficult choices Anna has to make to not help save her sister. Relative donors may be placed in a similar position, and may not have full autonomy to making a decision. In “My Sister’s Keeper” the mom continually pushes Anna to be a donor; in real life parents, siblings or spouses may act as the pressuring force. The situation of the need for a donor can also complicate things, the amount of time may force donors to make fast decisions without ample time to absorb all the information or to obtain proper consent. Veatch perfectly sums up this conundrum by stating that “actual consent is not obtained in all cases and even when consent is obtained, it may not be adequately informed or autonomous” (317). Informed consent is a confusing issue with one patient, and only grows in confusion with two related patients.