Who made me God? ( with all due apologies)

06/04/2009 at 5:47 AM Leave a comment

One of the ethical questions that used to come up was whether we should always tell a patient the truth. ( I was of the position that would say –DUH!) Or the entire truth, or wait a while. There are many situations where the answer is not so clear. An older very famous and respected doctor stated that if the patient was well known and histrionic ( read: woman) one might consider not telling her something that would feed the histeria, particularly if the husband agreed. ( Say What!! did we go into a time warp back to the time when women were chattel?) I hardly ever yell and rant out loud, this was one time.

But there are other more subtle cases. a woman wakes up from a coma. She and her son were in a car accident, he died, she is dying. Do you tell her her son is dead knowing she will blame herself? Do you temporize, saying he cant be moved but is in stable condition in the ICU? Thetemptation is high to do the latter?

Another one, my patient who has pancreatic cancer is driving his son when he has an accident that kills his son. Amazingly my patient survives with few injuries. He does not remember the accident ( very common) and is trying to deal with his sons death. It was a one car accident, no one else was hurt and from the police report it is clear that the patient was at fault. He shows me the police report that was written with care and subtlety. The policeman tried very hard to confuse the issue and did not come out and say what was between the lines, namely that the driver lost control of the car due to excess speed and not paying sufficient attention to the circumstances ( rain, twilight).

He shows me the report and asks me what I think. He wants to know the truth. But the truth is devastating. His son should have been driving, but the patient insisted. The accident was clearly his fault, perhaps the chemo, and his emaciation had an effect, but his judgement about driving was the problem.

This is one of the few issues that I am extreeme about: It is not my job to lie to someone. I did not apply for the job of  deciding who gets the truth and who doesnt.  If I am going to play God, I want a few hundred more IQ points and a lot less emotional sensitivity. When I was younger I would argue that it was never, ever, right to hide something from a patient. It did not mean that you beat them over the head with things but I would never obfuscate the truth. Perhaps I have mellowed in 25 years, but just a tiny bit.

What did I do with the patient? Tune in for tomorrow’s post.

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Egypt : a trip down Denial –part 1 The truth and nothing but the truth

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