lalalalalalala ethics & philosophy. I am terrible at all the rules and the defined this and that. So I shall simply weigh in on what I know! I will give you some examples where the second half of the statement isn't true-
1. The patient specifically asks that you do not tell him or his family the details of his condition. He may either wish to just receive treatment, or more commonly, to not receive treatment and just die in peace. At this point you can offer comfort care (i.e. pain meds, hospice, etc) if applicable and consented to by the patient. The patient should always be reassured that you will not abandon him.
2. The patient is a young child (or minor, really). In this case, the parents of the child decide what information that the patient gets to hear about their condition. While you should never ever lie to the patient (true), you are ethically required to respect the wishes of the parent in what the child can be told. If the child asks about their condition, we are taught to ask them, "What have your parents told you about your condition?" and go from there.
3. If the patient asks how long they have left to live, you are never to give them an actual time frame in months, even if your past experience suggests beyond all shadow of doubt that once a person has reached a certain point in a disease, they have exactly four months to live. You are to always give ranges, like, "At this stage in the disease, many patients usually have around half a year to live." Or "months to a year" or "a few years". The reason for this is obviously that there is always the possibility for some spontaneous miracle and you do not want people determining to "prove the doctor wrong" by "outliving" the exact time estimate given.
Those are just some things that came off the top of my head. I could also get into the "it is wrong to tell lies" part as it applies to medicine... like what I got asked at during my med school interview - "Say a kid needs a surgery NOW. If he doesn't get it, he'll live, but, he will never be able to walk or run again. Insurance won't approve it for another couple of weeks. But if you lie to the insurance company and say that he needs this surgery to save his life now, he will be able to walk and run again. What do you do?" and his follow up, "As you know, there are limited resources, what if this kid's surgery meant that 100 people could not get their medicine?" :P
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chiming
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Date: June 4th, 2010 05:13 pm (UTC)From:1. The patient specifically asks that you do not tell him or his family the details of his condition. He may either wish to just receive treatment, or more commonly, to not receive treatment and just die in peace. At this point you can offer comfort care (i.e. pain meds, hospice, etc) if applicable and consented to by the patient. The patient should always be reassured that you will not abandon him.
2. The patient is a young child (or minor, really). In this case, the parents of the child decide what information that the patient gets to hear about their condition. While you should never ever lie to the patient (true), you are ethically required to respect the wishes of the parent in what the child can be told. If the child asks about their condition, we are taught to ask them, "What have your parents told you about your condition?" and go from there.
3. If the patient asks how long they have left to live, you are never to give them an actual time frame in months, even if your past experience suggests beyond all shadow of doubt that once a person has reached a certain point in a disease, they have exactly four months to live. You are to always give ranges, like, "At this stage in the disease, many patients usually have around half a year to live." Or "months to a year" or "a few years". The reason for this is obviously that there is always the possibility for some spontaneous miracle and you do not want people determining to "prove the doctor wrong" by "outliving" the exact time estimate given.
Those are just some things that came off the top of my head. I could also get into the "it is wrong to tell lies" part as it applies to medicine... like what I got asked at during my med school interview - "Say a kid needs a surgery NOW. If he doesn't get it, he'll live, but, he will never be able to walk or run again. Insurance won't approve it for another couple of weeks. But if you lie to the insurance company and say that he needs this surgery to save his life now, he will be able to walk and run again. What do you do?" and his follow up, "As you know, there are limited resources, what if this kid's surgery meant that 100 people could not get their medicine?" :P