The typical relationship between the doctor and the patient is intricate and complex, consisting of unusual conditions, which combine knowledge along with a sense of values, morals, compassion, ones duty, and much, much more. The doctor must be equipped with these intricate particulars; nonetheless there are controversial issues and biomedical problems that tend to arise in any case. Physicians take an oath to look after the welfare of their patients, therefore some questions tend to arise, some of them being: Should a doctor always tell the truth to the patient? Are some patients in no condition to ever merit hearing the truth? This composition will be my attempt to answer these questions, based on what I have learned, my experiences, and my beliefs.
Primarily, I will share an experience in my life and use it as an example of one of my viewpoints. In March 2004, my father was diagnosed with acute appendicitis, and as a result had his appendix removed. Shortly after the operation, he was given morphine in order for the recovery to be simple and painless. What my brother and I noticed was a series of confused, and strange behavior. What my father started doing was getting out of his bed, turning certain objects on the feeding table, and seeing patterns of a map on the hospital floor. We were told that this was an effect of morphine, however, this behavior did not stop. My brother and I began to worry and asked for the doctor to do medical tests, to see if maybe there was something wrong with his brain functions. For a while, the doctor was reluctant to perform the tests, nonetheless he agreed. Everyone was stunned to what this chain of events has led to. The tests had showed that he had cancer that existed in the brain, the lungs and the adrenal glands, and it was spreading rapidly. The doctor had notified us of his condition, and also stated that he will not live more than six months. Naturally we were devastated and in a shock that words cannot describe. How can someone go to the hospital with appendicitis and end up having cancer all over the body? The doctor had informed us that nothing like this has ever happened, and my father�s case is very rare. The doctor had asked us if we wanted him to tell my father the truth, but we needed to buy some time, therefore he left it up to us, (the family) to tell him about his condition, later, if we wanted to. After some time, my father began to get a mixture of radiation and chemotherapy, and that�s when he began to suspect that he has cancer. He also began to question my mother, and after a while she withdrew, and told him. He accepted the truth, and with hope, along with modern technology (instead of giving up), chose to fight the dreadful illness. Thank g-d, but it�s been 8 months now, and we just found out last week that all of the cancer is completely and miraculously gone!
In my opinion, the doctor made a proper decision when he left it up to my family to tell him the truth. He had asked us, the loving and caring family members, if and when should the truth be told. And we felt that in this case, truth telling was a gradual process, and the timing was not right to tell him about his condition. If the case was different, for example, if a person does not have a family, like in Monica�s severe and complicated case, (Ethical Issues in Modern Medicine, P.64-65) where she�s heavily sedated due to difficulty breathing during a heavy
cough, and a lose of consciousness. Monica�s diagnosis showed that there are tumor cells of a poorly differentiated squamous cell carcinoma of the lungs metastatic to the lymph node. The tumor turned out to be inoperable, and chemotherapy and radiation therapy were decided to be an unproven benefit. The medical team also believed that she did not have more than three months to live.
I believe that different circumstances require different courses of action. Alan Goldman�s Medical Paternalism is described as the interference in judgment of others, for their own benefit. How does one know what would benefit someone, before knowing anything personal about that human being? For instance: the person�s values, beliefs, lifestyle, religion, or even preferences, also if the person is of strong or weak character. As beneficial as Medical Paternalism may sound, nobody should have the right to make any decisions for a person, accept that person him/herself, even in an extreme instance like in the Monica�s case. I strongly believe in Autonomy, which is described as the internal process of reflection, on the basis of which one can be called a moral being. It is the core of human independence and moral freedom. It basically defines that no one can be told what to do, or how to act, it is personal and up to the individual at hand. In the case of doctors (Ethical Issues in Modern Medicine, P.56) the question is whether they have the authority to make decisions for others that they would lack as nonprofessionals. Rights are recognized, partially to permit individuals control over their own futures. First is the presumption of their being the best judges of their own interests, which may depend upon personal value orderings known only to them. Wherefore, in my opinion, even in Monica�s case, the doctors should maybe wake her up, yet keep her sedated enough so that she�s not very uncomfortable, and at least �offer the truth�, so that she can decide how she wants to use up the little time she has left in this life. If she would decide that she does not want to know the truth, that would be her decision, and it demands respect. I am aware of the fact that the truth will be devastating to her, so in that case she may choose to remain sedated for the rest of the term, however there is an emphasis on �Monica�s choice�.
Many would perhaps say that Medical Paternalism would increase and maximize a person�s chance for survival, but in my opinion the truth has to be told one way or another, if the patient wants to know the truth. Goldman�s advice is to not tell, however, it�s a moral priority to not withhold that kind of information. I think that truth telling sometimes should come from a family member instead of the doctor, which will make the patient feel loved and give him/her a sense that the people or person who loves him/her the most will be there for him during this difficult time, as in my father�s case. I also think that before the patient wakes up, the doctor should talk to the family first, in order to find out if they want him to tell the patient the truth, because the family acts as a surrogate of the patient.
These are complicated issues, and perhaps everyone has different values and beliefs. One might completely believe in Medical Paternalism or Patient Autonomy, which is precisely my point. The human process of thought and rationale is utterly individual and it takes years of development - individual development to build up. No one can take that away from a human being, and no one should, but these are just my thoughts. http://www.PassNurseExams.com