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Ethics Review - Issue 2 Volume 2 - June 2003
The Ethics Team is prepared to meet to discuss specific clinical ethical issues. Hospital staff, patients and families who have concerns or need clarification about ethical aspects of patient care may consult the committee.
Dr. Jaro Kotalik
Email: jkotalik@tbaytel.net
S Hamilton
Email: hamiltos@tbh.net
(807) 684-6012
P Lee
Email: leep@tbh.net
(807) 684-6028
The following is a summary of the Roundtable Discussions held in March 2003 regarding Disclosure. The participants discussed four fictional cases involving the disclosure of information to the patient, family or visitors. The scenarios were chosen because it is recognized that staff members encounter these types of cases frequently, and also because some of the issues are challenging.
The patient has been in the hospital for over a week for various investigations. The nurse on night duty knows from the chart that the consultations and tests all suggest multiple sclerosis. The patient, who seems unable to settle for the night, approaches the nurse. “Tell me, what is my problem! I don't know why I am here. Do you know my diagnosis?”
Issues to Consider
- Purpose and values of disclosure (instrumental & principal).
- Duty to inform about diagnosis and prognosis.
- Whose duty is it to inform?
- Can you tell a white lie or a therapeutic lie to provide comfort at the moment?
- The art of telling bad news, e.g. have all data at hand, clarity, proper time and place for the disclosure, listen to patient, support, follow-up.
- What various disciplines might need to disclose (RN - side effects of medication / Radiation Technologist - risks during pregnancy)?
Patient was recently discharged from the coronary care unit to the medical ward. A man who identified himself as a brother of the patient approached the resident in family medicine when the patient was out of the room. “Did my brother have a heart attack or not? My sister believes that he had a heart attack but of my brother tells me that this is not true. If his condition is really serious I would be prepared to take time off and stay with him, but we need to know his diagnosis for sure.”
Issues to Consider
- Patient’s right to decide who should get information about his condition.
- Need of family to receive information in order to care for and support the patient.
- The importance that all receive the same information.
- Advantages and drawbacks of family conferences.
Patient has just returned from the recovery room to the surgical unit. Her family is concerned that she was in OR much longer than expected. You know that the x-ray machine in OR failed and in spite of attempts to fix it, it could not be used during the surgery as expected. The procedure was completed anyway. A family member asks: “Did anything go wrong?”
Issues to Consider
- Professional versus common standards of truth telling.
- Good reasons for telling the truth (promotes trusts, invites participation in decision making, allows patient to makes his life’s choices, hard to predict harmful effects of bed
- news, shows respect for patient, prevents deception; reduces susceptibility to harm, reduces legal liability).
The patient had a biopsy that showed evidence of malignancy and there is documentation of metastatic disease on the chart. Yet the patient is free of any symptoms related to this diagnosis. The patient's nurse knows that the wife and sister of the patient pleaded with the physician to not tell the patient about the diagnosis if it was an incurable cancer. The patient asks the nurse, " Is there is something seriously wrong with me? Is it time for me to ask the minister from my church to visit?"
Issues to Consider
- Competence of the patient.
- Language barrier.
- Cultural differences.
- What patient himself wants to know.
- Opportunity for patient to ask questions.
- Patient’s waiver of disclosure.
- Need for a consent to treatment.
- Who should communicate what?
Centre for Health Care Ethics
Thursday, June 26, 2003
7:30 PM "Umbilical Cord Blood Banking: Ethical and Legal Issues"
John Akabutu: MD, Professor Emeritus, University of Alberta; Director, Alberta Cord Blood Bank, Edmonton
Yolanda MacKinnon: BSc, MA, Research Consultant, Northwestern Ontario Technology Centre, Thunder Bay
Bradley Smith: BSc, LLB, Weiler, Maloney, Nelson; Ethics Team, Thunder Bay Regional Hospital
Robert Thayer: PhD, President & CEO, Genesis Genomics, Thunder Bay
Dimitrios Vergidis: MD, FRCPC, Head, Medical Oncology, Northwestern Ontario Regional Cancer Centre, Thunder Bay
Place: Health Sciences North - Teleconference Room
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