Case studies - Following on from Truth telling Question.?!
Question: A 65 year old man comes to his physician with complaints of abdominal pain that is persistent but not extreme. Results reveal that he has metastatic cancer of the pancreas. The man has just retired from a busy professional career, and he and his wife are about to leave on around the world cruise that they've been planning for over a year.
Should he be told about his diagnosis?
A 78yr old Asian woman is admitted to hospital with weight loss, weakness and a pulmonary mass. Results show that she has pulmonary TB. Her family approaches the physician and asks that the patient not be told, stating that in her upbringing in mainland China TB was considered fatal and to tell her would be like giving her a 'death sentence'.
Should the families concerns be respected?
Answers: A 65 year old man comes to his physician with complaints of abdominal pain that is persistent but not extreme. Results reveal that he has metastatic cancer of the pancreas. The man has just retired from a busy professional career, and he and his wife are about to leave on around the world cruise that they've been planning for over a year.
Should he be told about his diagnosis?
A 78yr old Asian woman is admitted to hospital with weight loss, weakness and a pulmonary mass. Results show that she has pulmonary TB. Her family approaches the physician and asks that the patient not be told, stating that in her upbringing in mainland China TB was considered fatal and to tell her would be like giving her a 'death sentence'.
Should the families concerns be respected?
Tough questions - good job!! If I'd seen the recently-retired 65 y/o male with pancreatic cancer, I believe it would be absolutely necessary to tell him his diagnosis. As treatment for metastatic pancreatic cancer is, as far as I can recall, palliative at best, I believe he would appreciate knowing his diagnosis and what the current treatment options are. This is a guy who's probably used to being in charge and meeting challenges head-on. In all likelihood, he would probably choose to go on the cruise with his wife to have the "time of his life", rather than risk losing any time, wasting away in a hospital bed. I've had patients tell me they'd rather spend their (last) days living instead of dying. I also think it would be a tragic disservice, not to mention gross malfeasance, to my patient if I told him it appeared to be something benign and he found out later from someone else that he'd had a terminal condition and hadn't spent his last days as he'd wished.
The 78 y/o Asian female is a bit tougher. Taking her family's cultural background into consideration, I'd still strongly recommend initiating treatment, as pulmonary TB is very treatable, even in the geriatric patient population. And, with the family (those in close contact with the patient) being treated prophylactically, treating "our" 78 y/o patient for her "infectious pneumonia" would be much easier for her to tolerate in the presence of family who love and revere her. The clinical diagnosis of "pulmonary tuberculosis" would not necessarily need to be voiced unless she was unable to tolerate standard treatment regimens and needed an Infectious Disease (sub-specialist) consult.
from a doctors point of view, they are obligated to inform and treat their patients...unless the PATIENT asks not to be treated or informed. in the Asian woman case, the family members do not have the right to ask the doctor to withhold his diagnosis. he is also obligated to tell the man about the cancer even if there isn't any treatment options. not doing so could result in the doctor being sued by the patient for negligence.
65 year old retired men , are 5 years from deaths bed unless they find an activity that gives their heart work , that is something all men should be told ,
78 is probably the last interstate you will traviling down , if you have to go to the bathroom the whole time ,makes the trip not pleasent , stay home , enjoy the day