Medical Ethics Dilemma

RevenantsKnight

Diabloii.Net Member
Medical Ethics Dilemma

Here’s a medical ethics situation that I thought might interest some folks, though it is a little grim: pretend you are a doctor caring for an eleven year old girl suffering from serious kidney failure, caused by AIDS. She was infected with HIV from her mother, who is currently comatose; her guardian is now her maternal grandmother. The girl’s prognosis is not good, and she is not expected to live much more than another year or so.

At this point, the girl is aware that she has kidney failure, but her mother never told her why (that is, that she has AIDS.) She has, though, asked her mother straight up about it, and at the time, her mother said no, you don’t have AIDS. Now, she is beginning to ask directly if she does have AIDS or not.

Her grandmother is vehemently opposed to telling her the truth; she argues that it is not necessary to burden the girl with that knowledge, and also worries that she might think negatively of her mother if her previous lie is exposed. Additionally, she believes that it is not your choice to reveal this information or not, because it will undoubtedly affect the girl and her family as a whole, while only the girl is under your care.

Though it cannot be doubted that the grandmother’s concerns have weight, some members of your medical staff are distinctly uncomfortable with the idea of hiding the diagnosis from the girl; not only do they feel that keeping the truth from her contradicts their role, they worry that, in the course of her treatment, situations will arise that will be very difficult to explain without telling the truth. The girl is also actively asking about this matter, and bioethics tends to emphasize respecting a competent patient's autonomy in decisions. Even though the girl's competency is not entirely clear, as she is a minor, some among your staff feel that she should be entitled to an answer.

Interestingly enough, state law is silent on this matter. Nothing compels you, as the doctor, to follow either path. The choice here comes down to your ethical viewpoint alone. Also, the previously listed reasons for and against telling the girl that she has AIDS are obviously not comprehensive.

Given the above circumstances, would you tell the girl that she has AIDS or not if she asks you? If you do not tell her, would you avoid answering or lie, and would you tell her the truth under different circumstances?
 

Yaboosh

Diabloii.Net Member
Why would you ever tell her? I don't think this is a very hard decision. You need to make her age higher for this to be a close decision (to me at least).
 

Lord Nyax

Banned
Doctor's should never flat-out lie to people asking direct questions. Some subtlety isn't bad, but lying can't be supported.

EDIT: Dondrei's right, tell her she's got AIDS if she asks; you don't have to volunteer any information about where she got it though.

EDIT#2: I feel left out...:sad:
 

Dondrei

Diabloii.Net Member
Well, I think that ethically a doctor should be required to tell patients everything they know about their state of health (and possibly everything they suspect too), but I don't know about them having to tell the child she got it from her mother.

On the other hand the patient is under-age, so everything becomes very murky.
 

RevenantsKnight

Diabloii.Net Member
Yaboosh said:
You need to make her age higher for this to be a close decision (to me at least).
Interesting. I'm genuinely curious, so my apologies if this comes off as overly aggressive, but is there a point before legal majority where you would consider this to be debatable?

Dondrei said:
Well, I think that ethically a doctor should be required to tell patients everything they know about their state of health (and possibly everything they suspect too), but I don't know about them having to tell the child she got it from her mother.
Might you think, though, that if the girl is intelligent enough to suspect that she has AIDS, she could take her mother's situation and her diagnosis and put two and two together? Besides, she already asked her mother, who denied that she had AIDS, so it's not like you can just reveal one without casting some hints towards the other.

I'm not trying to say that your choice isn't a valid one, by the way; I'm curious as to how you'd address these issues.
 

Yaboosh

Diabloii.Net Member
She isn't dying of AIDS, she is dying (technically) of kidney failure. If she is intelligent/curious enough to wonder what is causing her kidney failure, then I can see this being a question, but going against her family's wishes in this case doesn't seem right at all. It does nothing to help the girl. Ignorance seems like bliss in this situation.

As for an age where it becomes more debatable in my mind, well, of course it depends on the girl, but I would say not typically before 16-18. Even then, as long as there is a legal guardian expressing disdain for informing the girl of her entire condition, I think it is a case of ignorance of the specifics being better for everybody.
 

KillerAim

Diabloii.Net Member
I look at it a little differently. I think that the doctors have a duty to comply with the parents' wishes up to the point that it would require that they lie to the girl.

If the girl specifically asks if she has AIDs, tell her that her guardians have requested that the doctors only discuss her case with her mother or grandmother. If the girl figures out the situation from that response, so be it.
 
I have four words for you:

What would House do?
Slightly OT: Anyone losing interest in the show because of his insane self-destructive path? I could deal with the pills, but this risk everything movement is making me not like the show anymore. And that cop is pissing me off.

Back on topic. I would let her know how that she is dying. I'm not sure, but is the kidney failure brought on by the AIDS? If so, I would tell her the truth. If not, just say it's kidney failure.



 

FirsTimer

Diabloii.Net Member
If her guardians are asking that you not disclose any specific information about her condition, then I would refer the child to her guardians. I would imagine that most families would rather enlist the help of the doctor in explaining what is happening than try to explain themselves, unless they are planning to lie to the girl about her condition.
The line I would draw is when they ask you to perpetuate the lie. In short, lying is not the route I would take. If she asks directly, I would have to say, "Your guardians know all about your condition. You need to ask them." If it pisses them off, then so be it, they should try being a little more honest with their kid.
 

P2blr

Diabloii.Net Member
when you go to the doctor, the doctor tells you why you are sick, how is this an ethical question?
 

Yaboosh

Diabloii.Net Member
Ummm because the girl is 11 years old and her legal guardian doesn't want you to make statements that she thinks may deleteriously affect her grandchild's short life?
 

Dondrei

Diabloii.Net Member
What would House do?
Go off on a long cynical spiel about the situation with some superficial social analysis thrown in to grab the audience's attention, try a bunch of radical techniques to save her that cross all the lines of medical professionalism, and then ultimately figure out she doesn't have kidney failure or AIDs at all, but rather Histiocytic Necrotizing Lymphadenitis together with Wegener's Granulomatosis which was masked in all the tests by the presense of Lupus, brought on by contact with a rare kind of South African briefcase lined with tapirskin that hasn't been made since the 1920's.

Might you think, though, that if the girl is intelligent enough to suspect that she has AIDS, she could take her mother's situation and her diagnosis and put two and two together? Besides, she already asked her mother, who denied that she had AIDS, so it's not like you can just reveal one without casting some hints towards the other.

I'm not trying to say that your choice isn't a valid one, by the way; I'm curious as to how you'd address these issues.
Well yes, the disclosure of her condition would mean that unless she's dense she'll figure out that the mother gave it to her. But I don't think that should be the doctor's concern, that's just an unfortunate circumstance. They should act always to completely inform their patients and if that has side effects that's just too bad.

Slightly OT: Anyone losing interest in the show because of his insane self-destructive path? I could deal with the pills, but this risk everything movement is making me not like the show anymore. And that cop is pissing me off.
I haven't seen it in a while, largely due to inconvenient scheduling and jerking around on the part of the networks here, but more Hugh-Laurie centred drama can only be a good thing.



 

Star Dust

Diabloii.Net Member
Tell her. She's going to find out anyway. The earlier she is told, the more time she has to cope with the truth.
 

RevenantsKnight

Diabloii.Net Member
By the way, the reason I didn't make the girl older is because this is based off of an actual case. The doctor's actual decision was to not say anything unless asked directly, and then, under those circumstances, inform the grandmother that they would not lie to the girl and request that the grandmother be present when they told her.

ModeratelyConfused said:
Back on topic. I would let her know how that she is dying. I'm not sure, but is the kidney failure brought on by the AIDS? If so, I would tell her the truth. If not, just say it's kidney failure.
Her kidney failure is an indirect result of her having AIDS, though since she's asking straight up if she has AIDS, not why she's dying, I don't think a simple "you have kidney failure" is really an option.

Dondrei said:
Well yes, the disclosure of her condition would mean that unless she's dense she'll figure out that the mother gave it to her. But I don't think that should be the doctor's concern, that's just an unfortunate circumstance. They should act always to completely inform their patients and if that has side effects that's just too bad.
I'm just playing devil's advocate here: a drug with psychological side effects would definitely need to be examined for its impact before administration, and certainly many doctors might hesitate at prescribing such a substance if the side effects were severe enough. Would you claim that information is somehow different than this, despite the similar impact on the patient?

(Feel free to not answer if you don't really want to discuss this, of course.)

Lostprophet said:
I have four words for you:

What would House do?
I don't think I'd want to know...
 

Dondrei

Diabloii.Net Member
I'm just playing devil's advocate here: a drug with psychological side effects would definitely need to be examined for its impact before administration, and certainly many doctors might hesitate at prescribing such a substance if the side effects were severe enough. Would you claim that information is somehow different than this, despite the similar impact on the patient?
Hmm, I find that line of reasoning rather disturbing. I mean, doctors are supposed to look out for the best interests of their patients, but if they start thinking about whether or not being honest with them is in their best interests... scary. It's like one of those old sci-fi stories where the machines are faithfully following the Laws of Robotics when they decide to control the human race For Their Own Good.

(Feel free to not answer if you don't really want to discuss this, of course.)
No no, this is an interesting debate.



 

AeroJonesy

Diabloii.Net Member
You don't tell her unless she specifically asks. Although I doubt an 11 year old girl would ask "hey Doc, do you think there's an underlying cause of my illness?" And you make sure to tell the parents that if the girl asks, you will tell her.
 

blu3l1ghtn1ng

Diabloii.Net Member
Well, if you tell her that she has AIDs then there is a whole family uproar about the entire situation because her family has lied to her. I believe that the best course of action is to talk to the family, and tell them that in the course of your treatment the truth will come out and that it is better coming from a family member than a doctor. At least in this case they will know the complexity of the situation.

Moreover, from the age of 13 and up you should be able to know what is happening to your own body. It is unfair to penalize the individual because society doesn't recognize them as young adults. They have the moral right to know whether or not they are going to die/suffer other problems etc.
 

Star Dust

Diabloii.Net Member
Yaboosh said:
Why exactly is she going to find out?
Somebody will tell her sooner or later. She'll start to notice the answers to her questions aren't the truth. She'll press her questions harder, especially as her condition worsens.
 
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