DOS 518 - Week 1 Discussion
The patient's mother intercepted the physician before he saw the patient to let him know that the daughter did not know of the diagnosis of leukemia and he was NOT to tell her. He asked her to explain the situation further. She indicated that when the diagnosis was originally made, she kept the diagnosis from her daughter. She requested the everyone involved in her care agree to tell the daughter that her problem was an unusual anemia. Apparently, they complied. When the leukemia went into remission, the mother considered this chapter of her daughter's life closed.
When the daughter fell in love, became engaged and made plans for a wedding, the mother did not share the previous diagnosis with either the daughter or the fiance. When the physician asked the mother why she had not made the disclosure, she responded "I had enough problems to deal with and I didn't need any more." The mother asked where the physician lived. He replied and she said "Oh dear! A number of my daughter's friends live in the near area. I'm concerned that they will hear of her diagnosis from you." The physician was astounded and insulted.
The mother was preoccupied with the need to protect her daughter from the diagnosis of leukemia and unable to recognize that the physician would be confidential with patient records.
Initial Post: Informed Consent Requires Disclosure
1. If you were the physician, what would you have said to the mother when she told you NOT to tell the daughter?
I would deflect the course of the conversation in order to avoid addressing the mother's request. The daughter is an adult who is presumed to be competent to make her own healthcare decisions.1 The mother has no legal right to make decisions about what the daughter can or can not know about her personal health now that she is no longer a minor. The mother has clearly already been excluded from the decision making process based on the fact that the current course of chemotherapy would have required informed consent. That process would mean that the daughter already knows her diagnosis. If the mother still thinks that her daughter does not know her diagnosis, then it is clear that the patient has chosen not to share all of the details of her treatment with her mother.
2. If you were the physician, what would you have done in this situation? Would you have told the patient about her leukemia? Why or why not?
Initially I would be operating on the presumption that the patient has already been told her diagnosis at the time she started her treatment for her relapse. Informed consent for treatment requires that a patient has full understanding of their personal health information, including medical history, results of diagnostic testing, and options for treatment. Just to be sure, I would check the patient's chart to find her informed consent documents and verify this assumption. If I found that the patient had NOT been informed of her diagnosis, I would be obligated to tell her in the course of providing any additional care to her. I would be certain to have at least one witness during her informed consent process for her current treatment, and I would seek legal council as soon as possible since I was about to be a whistleblower on the lapse of duty to the patient. Hopefully my initial reading of the situation would have been correct and none of this drama would be necessary.
3. Can you think of a few reasons why the mother may not want to share the news of the diagnosis with the daughter?
The mother is trying to continue the preistly model of care that she clearly took on as legal guardian to her daughter during treatment for her original diagnosis, in which she made decisions for her daughter and not with her daughter. Now that she is beginning to realize that her daughter has a right to know her true medical history, she is worried that her daughter will react badly to not having been told the truth during her childhood treatment. By trying to avoid a rift in her relationship with her daughter based on this revelation, the mother is trying to serve her own purposes more than her daughter's.
4. At what age dose the patient have the right to know her diagnosis?
The patient has a right to know her diagnosis at age 18 when she is legally an adult and able to give consent.
- Lenards N. Introductory Healthcare Ethics. [SoftChalk]. La Crosse, WI: UW-L Medical Dosimetry Program; July 14, 2014.