Play along...

[tinyjo]

OK, just for fun, here is the essay question I will be answering this afternoon:

‘It is wrong to tell lies, so patients should always be told the truth about their condition.’ Is this a good argument?

I've turned off emailing comments on this and I promise not to look until I've written the essay (1000 words, in case you're interested). What do you think?

Comments

[prissi.livejournal.com]

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

[lady-angelina.livejournal.com]

I've worked in various medical settings, and I've seen doctors do things like declare that a patient has depression (when they didn't really), just so that the insurance company would pay for buproprion for smoking cessation purposes (which the insurance company will not pay for). You could say that the insurance companies themselves are highway robbers unto themselves, but that's not a discussion I care to get into while my brain is still waking up. XD

But yeah. As always, you make lovely points, Prissi. <3

[prissi.livejournal.com]

<3


Yeah, my opinion re: lying to insurance companies is this - really you shouldn't do it because it's better not to lie, but when quality of a patient's life is at stake, or life-saving treatment is needed, I think as physicians and human beings our ultimate responsibility is to other human beings, not corporations. Obviously going to a religious school, the 10 commandments came up during that conversation, and my answer was basically that the first five commandments are about our relationship with God, while the last five are about how we should relate to our fellow human beings. I do believe, ethically and morally and spiritually and whatever else, that our responsibility as *PEOPLE* are to other people first and then only to some giant institution/corporation. You could pick this apart many different ways, and obviously I do not believe that it is ethical or moral to completely ignore the HMOs' rules and regulations just because people >>> corporations, but I do believe that as a general statement, a physician's ultimate responsibility is to humanity, and to do what it takes and what is possible to preserve the quality of life of each patient.

I don't know that I'd be willing to continually record that a pt has depression just so they could get buproprion, something like that done habitually, I feel would compromise my integrity over time. though why the hell do they not cover something like that, I cannot imagine... O_____O smoking being the #1 cause of preventable death and diet & exercise levels being #2... it's gotta cost a lot more to take care of the emphysema and stroke and the other fallout. O___________O seriously? insurance companies don't cover wellbutrin for smoking cessation? there is something seriously wrong here.

[tinyjo.livejournal.com]

That's really interesting stuff! (1) was dealt with in some of my course reading, but 2 and 3 are examples I haven't considered at all.

Do American doctors get given a specific ethical framework to work with (e.g. the Four Principles, as I outlined to Alex above) or do you get given general instruction and left to figure things out yourself?