In a recent episode of the television medical drama "House," the doctors are faced with a troubling decision. A patient has less than a day to live if she doesn't receive a liver transplant, and her partner has offered to donate a portion of her liver. But the patient has told the doctors that she had been planning to leave her partner because she was "tired of her."
The lead doctor warns his colleagues not to tell the donor of her partner's intentions. When one of the other doctors argues that not to disclose the information would be unethical, the lead doctor responds by saying that it's not medical information and that to disclose it might hinder their own ability to save their patient's life.
What do you think? Should the doctors tell the donor of her partner's intentions, in case it would affect her decision to make the donation? Or is it right to withhold the information, given that the patient might die if the liver is not donated?
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4 comments:
On the Doctor Question:
I believe the doctor should keep quiet. The information of the patient planning to leave his partner was most probably given in confidence and the doctor has no right to divulge it. There is also the possibility that the patient might change his mind about leaving his partner because of her generosity.
Emmanuel Tchividjian
Ethics Officer
Ruder Finn, Inc.
301 East 57th Street,
New York, NY 10022
tchividjiane@ruderfinn.com
Don't really see the problem here. The "doctor(s) were told by the PATIENT about her/his intent...part of Dr./Patient privilidge thing, isn't it? Therefore, the question cannot really be considered as to telling the 'donor' what is going on. And, in reality, the 'patient' may not be in his/her right mind...death's door thing.
Now, come up with something really interesting. Phillip Brandt
It is right to withhold the information, given that the patient might die if the liver is not donated. I think Dr. House made the right decision and I approved of the way he told the patient (after the fact) that she was a bitch for trying to get rid of the donor in her life because the donor was putting her life in jeopardy in order to save the patient. However, the donor did have an ulterior motive for donating. It was her intention that from now on the patient could not leave her because of the sacrifice.
Your column is one of the best and Dr. House is also one of the best.
Eileen Chitruk
Windsor, Ontario, Canada
The Windsor Star
Let's take the problem out of the realm of TV melodrama and into the real world:
First, the donor also becomes a patient at the hospital as soon as she is accepted as a transplant donor, and is entitled to the same medical care and concern as the original patient.
Secondly, on every hospital transplant unit, both patients will be asked to undergo a psychological assessment to determine if both are appropriate patients for the procedure. It is during this assessment that the issue can or will come up.
Thirdly, the original patient's intention or plan may be a product of her illness and could very well change when she is well again and under less stress. Passing on this information to the donor would be highly unethical, and a breach of the first patient's confidentiality. It is also meddling, and could negatively affect both patients psychologically, causing more stress for both of them and increasing the possibility of a negative outlook for surgery.
So, which doctor is right? The lead doctor is correct in telling the other doctors not to pass on the transplant patient's intentions. However, he could have told his staff (the other doctors) that the two patients would be assessed by a psychologist or psychiatric social worker. Or, if they have already been assessed, he could have told his staff that the two women were deemed appropriate for the procedure. This would allay any concerns the other doctors might have.
He is also correct when he said that the information is not medical. What he could have said was that their concern should be only the medical, and that the psychological aspects of the case should be left to the other specialists.
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