Luiza Niyazmetova

Case 4.

In this case, the diagnostic evaluation of patient Mrs. M shows that she has a lung mass,

which is probably a cancer. However, the dilemma is that her husband and son ask not to tell

about the diagnosis to Mrs. M.

Depending on the actions that the doctor will take, three main courses of action are

possible in this case. First option for action would be to tell the true results of the diagnosis to the

patient. In terms of ethical and legal considerations, the first option maintains the patient’s

autonomy and justice which imply respect for person’s legal right to choose the treatment if she

is competent. As a professional, doctor also maintains public trust and acts to benefit the patient

wellbeing. However, if Mrs. M’s relatives are right, and this news would harm her, then, the

principle of non-maleficence may be violated.

The second option is that the doctor will agree with the patient’s relatives and will not

reveal the findings of the diagnostic test to her. Apparently, this will violate patient’s autonomy

and public trust. Furthermore, another ethical principle, in particular respect for the law, is

broken. This is not acceptable in most cases because person’s legal rights must be respected.

Choosing this option may reveal unprofessional behavior of the doctor who puts all

responsibilities for the patient on her relatives. Nevertheless, sometimes, professionals should

consider some exceptions that would justify withholding the truth from the patient. One

exception is when the patient clearly expresses that she does not want to know her diagnosis,

which is indeed the legal right of not knowing. Another exception is when her relatives give a

strong argument of that telling the truth will cause a real harm to the patient.
 Third option is to suggest more definitive diagnosis to confirm the presence of lung

cancer because it is not completely certain that she has lung cancer. Before the diagnosis is

confirmed or rejected, doctor can explain to the patient about possible outcomes of the additional

test and about the treatment options in a very soft manner in order to prepare Mrs. M for the

worst outcome. If the test results are positive, the doctor ought to tell about the true results to the

patient and to discuss treatment options with her. This option more carefully considers ethical,

legal and professional principles. This course of action allows respecting patient autonomy

without violation of the law, without harming the patient and acting in the best interests of the

patient. The patient, if her competence is confirmed, should know the diagnosis and all treatment

options, including possible risks, underlying each type of treatment, in order for her to decide

what to choose because it is Mrs. M who will be signing informed consent about treatment

acceptance or refusal. Clearly, if the examination shows that Mrs. M is not competent, then her

relatives will be responsible to make the decision. In addition, third option allows the doctor to

avoid breaking professional code of conduct and to stay in frames of moral and legal standards.

Analyzing the three courses of action, I suggest the third option as the best one because it

allows benefiting the patient the most, reducing harm to her emotional status and without

violating her Constitutional rights to know the true diagnosis. Also, it maintains truthful doctor-

patient relationships and shows that the doctor is responsible, competent and knowledgeable

enough to provide patient with the best available care. The next best option would be the first

course of action when the doctor reveals the true results of the diagnosis to the patient. It can be

considered as the “next best” option because it does not violate patient autonomy and legal
rights. Although it may violate “non-maleficence” ethical principle, this option better reflects

physician’s professional behavior of taking responsibilities and acting in patient’s best interests.

All possible course of action was clearly described and distinguished. Ethical principles

for each possible options are described properly. Legal principles were mentioned but didn`t

properly described. Professionalism concepts are defined to each listed options. Therapeutic

privellege could be mentioned. References could add more credibility. Esp to laws and

regulations

In general, essay very well structured, conclusion has own opinion.

Grade: 13.6/ 15