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Saturday, June 03, 2006

SOUND OFF: BEST INTENTIONS

In a recent episode of the television medical drama "House," doctors had to decide whether to inform an organ donor that her partner, to whom she was planning to donate part of her liver, had told one of the doctors that she planned to leave the donor. The lead doctor warned his colleagues not to disclose the information, since it might dissuade the partner from making the donation. Did he make the right call?

"I think Dr. House made the right decision," writes Eileen Chitruk of Windsor, Ontario, and most of my readers who responded agreed with her.

It's a no-brainer for Phillip Brandt of Costa Mesa, Calif., who believes that the disclosure should be covered by doctor/patient privilege.

Emmanuel Tchividjian of New York agrees. "The information of the patient planning to leave her partner was most probably given in confidence and the doctor has no right to divulge it,"Tchividjian writes. "There is also the possibility that the patient might change her mind about leaving her partner because of her generosity." Check out other opinions or post your own at:
http://jeffreyseglin.blogspot.com. (The original question was posted at
http://jeffreyseglin.blogspot.com/2006/04/truth-and-consequences.html
.)

Jeffrey L. Seglin, author of "The Right Thing: Conscience, Profit and Personal Responsibility in Today's Business" (Spiro Press, 2003), is an associate professor at Emerson College in Boston, where he teaches writing and ethics. He is also the administrator of
http://jeffreyseglin.blogspot.com, a Web log focused on ethical issues.

Do you have ethical questions that you need answered? Send them to rightthing@nytimes.com or to "The Right Thing," New York Times Syndicate, 609 Greenwich St., 6th floor, New York, N.Y. 10014-3610.

1 comment:

Leslie Ray said...

This situation does not present a simple, narrowly-defined question of doctor-patient confidentiality, though that is a major aspect.

If the physicians have a professional relationship with both patients, there is a conflict of interest which needs to be addressed. Part of a doctor-patient relationship is the duty for Full and Informed Consent, though whether this applies to the social implications of the decision as well the medical ones could be argued.

If the relationship is only with the recipient, then it seems the recipient has ensnared the physician in complicity with her lie. However, exploration of why she mentioned this fact at all is necessary - was she seeking support for a decision she believed was wrong or in someway expressing ambivalence? In addition, the social support that will be needed following the transplant needs to be considered. Who will care for the patients during their recovery (which will be at home, not in the hospital)? Implications of the effects of severe emotional distress upon health are considerations in addition to the technical aspects of the transplant.

In either case, to tell or not to tell are not the only courses of action. Most hospitals have an ethics committee who can be called upon to assist the physician in considering the ethical implications of situations. They might also assist the patient in wrestling with her decision. The 'what' may remain the same, but the 'when' and 'how' have ethical considerations as well.

Bottom line - maybe the decision is the correct one. But, this is not just about the physician. Without a broader consideration of the ethical questions and implications, the process leading to that decision is severely flawed.