Ethical issues in health care

Read The Case below then answer the following questions

  1. How would you have wanted to be treated in this situation if you were the patient?
  2. Do you think this doctor failed by not, from the start, telling everything he knew (or at least believed) about his patient’s future?
  3. If you had been the doctor in this case, how would you have managed the disclosure of news to this patient?

Dr. Tom Beauchamp: (3:09) To bring these abstract statements of the problem down to the concrete world of medical practice, consider an actual case from rehabilitation medicine that was reported in the Journal of the American Medical Association. Here are the facts in this case. For a month, a physician in a stroke rehabilitation unit has carefully managed information in disclosures with a patient who had suffered a stroke.

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During the very first session, the patient asked how long it would take for the arm to improve. The doctor was confident that the patient was unlikely to recover significant use of his arm, but the doctor held back on the presentation of his full set of beliefs. Intentionally avoiding a direct answer to the patient’s question, the doctor stressed how difficult it is for physicians to make adequate predictions about time or about the extent of recovery. He mentioned that the brain itself needs a chance to heal.

The patient seemed reasonably satisfied with these answers at the time and in the conversation that followed seemed comfortable with this situation of uncertainty. He told the doctor that he greatly fears permanent paralysis and has strong hopes that his recovery will go well. This sort of indefinite and noncommittal, yet caring and supportive, exchange of views continued with the physician constantly praising the patient’s progress, despite some clear residual weaknesses.

After two weeks of rehabilitation, the patient suddenly became enthusiastic about some parts of his progress, for example, his leg improvement. And he asked the doctor, now, how about my arm? The physician said, the arm may not recover as much as the leg. Which was true, but hardly the whole truth.

This physician had learned from experience that his patients generally have a strong hope for a return to their previous capabilities and that a straight dose of bad news tends to overpower any good news about the likelihood of progress in rehabilitation. The doctor was convinced that staged disclosure is an appropriate form of medical care of patients and that it is thoroughly justified for at least some patients.

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