Friday, May 14, 2010

Stories from the Clippings

Do not Spare Them - They Can Take It

There seems to be a plethora of articles written about medical ethics and the principles of self-determination and disclosure. The subject of disclosure not only pertains to medical error but also to whether a physician is obligated to disclose the "truth" about (in the article referenced) the prognosis and treatment of cancer patients with advanced disease. It begs the question of whether to uphold informed consent and self determination processes, in which a patient has the right to make decisions concerning how they want to proceed from diagnosis, versus a physicians concern with preserving a patient's faith in treatment and the brutal impact disclosure might have on the patient's unrealistic expectation of therapy.

"Some cultures do not place a great emphasis on informing the patient of the diagnosis, especially when cancer is the diagnosis. Even American culture did not emphasize truth-telling in a cancer case, up until the 1970s."[i]

In this light, it seems that Dr. Bernard P. Harpole, clinical instructor in surgery at the University of Oregon Medical School, (and, at the time, president-elect of the Academy of General Practice) was either ahead of his time or was encouraging physicians to hark back to earlier times before paternalistic healthcare overshadowed autonomy. The article describes a study published in the April 1955 issue of Current Medical Digest, which revealed his findings concerning disclosure. He garnered information from questionnaires sent to 141 cancer patients with advanced disease. The survey asked whether they preferred full disclosure of their prognosis and the treatment of life threatening illnesses or if they would rather not know the entire truth.

According to Harpole, only 3% did not wish to be informed of their condition. 85% of patients replied that they would want to know when the date of death is predictable and 2% wanted to be notified when death was inevitable. And 96% wanted to know if their parent, spouse, or a child was suffering from an incurable disease. In a second questionnaire, he found that most respondents understood what cancer is and how to recognize some symptoms. He credited the efforts of the medical profession to educate the public but also emphasized the need for continued education.

Dr. Harpole exhorted physicians to reexamine the merit of withholding the truth from patients. Further he contended that withholding the truth is a sure-fire way for patients to lose confidence in the physician. More of the population, he said, understands disease and therapies and are more capable of making their own decisions concerning their future than one might think.

Articles referenced: f1-p56-a1, 3-4

[i] Wikipedia Medical Ethics

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