A 35-year old woman is diagnosed with metastatic breast cancer. By the time of the diagnosis, the cancer spread throughout her body; surgery is not an option. The physician treating her determines that chemotherapy and radiation cannot be used at this advanced stage. Patients diagnosed with cancer at this stage rarely live more than a year.
The physician knows that the patient has been working on her first novel for two years and that completing it is her life-goal. She expects to finish it in the next three-to-four months. The physician believes he can stall giving the correct diagnosis and prognosis through deception and evasive answers until the novel is complete. He is worried that the patient will become depressed and unable to finish the novel if an honest diagnosis and prognosis is shared at this time. The physician and patient have never discussed how a situation like this should be handled. The patient does not have a significant other and, while friends have offered support, her family members have not.
The patient has a close relationship with one of the nurses in practice with the physician. The nurse is aware of the physician's plan. Although this position relates specifically to a physician's responsibility for disclosure, there are implications for nursing, as well. In this case, physician and nurse have opposing perspectives: the physician sees disclosure or non-disclosure within his control and purview; the nurse upholds veracity without exception based upon supporting individual rights, respect for the person, and the principle of autonomy.
Successful collaboration (and thus, the best outcome for the patient given the circumstances) requires the physician and nurse to recognize each other's viewpoint during the decision making process.
Selected readings in this module clearly support this case. Before you begin, be sure to complete the readings and all learning activities. Then, answer the following questions concerning the scenario above. Each response should be noted in one clear, succinct (short!) paragraph. As always, support as needed.
Recognizing that health care is an interdisciplinary effort:
1.Identify the model of interaction that best describes the relationship between patient and physician.
2.What ethical principles form this case from both perspectives-the physician and the profession of medicine and the nurse and the profession of nursing?
3.How would the relationships between physician-patient, nurse-patient, and physician-nurse be affected if: 1) truth was told; or 2) truth was withheld?
4.What if an ultrasound technician, working under the direction of the physician, had detected the spread of the cancer, and was also an acquaintance of the patient? What options would the technician have in this situation?
5.What is the best way to resolve a discrepancy like this?
6.How does working through a case like this contribute to the sociology of health, healing, and illness?