112.

OOI JIA YI (1300573)

Case 2 – Mrs. Lee

An 80-year-old Asian widow is hospitalized with weight loss, generalized weakness, and
a pulmonary mass. Work-up reveals that she has pulmonary tuberculosis. Her oldest
son approaches the physician and asks that the patient not be told, stating that in their
culture the elderly are protected from such distressing news. In mainland China,
tuberculosis was considered fatal and to tell her would be like giving her "a death
sentence." Should you respect the son’s approach? Give reasons.

The ethical issue involved in this particular case involved sharing the bad news with the
patient. The eldest son had personally requested me to not disclose the truth about his
mother’s illness to her.

The ethical dilemma to be faced in this case involves the principle of veracity which refers to
the ethics of telling the truth and is one guide of the conduct of medical practitioners. While
this principle is not a law, violation of ethical principles, including veracity, will result in a
loss of credibility and respect with other professionals and patients alike.

A good reason for telling the truth include being honest to the patient obeys the principle of
veracity and is an act of being respectful to the patient as she has the right to know the truth.
Telling the truth allows for a better and more open discussion with the patient and her family
about the options of treatment this will facilitate treatment. Keeping the patient in the blinds
will not allow a transparent and objective view of this particular matter. I also believe that by
deliberately hiding a secret from the patient, a physician will probably be slightly distracted
from his or her true responsibility that is, to treat the patient and to alleviate her suffering. A
lie has to be covered with another lie, and this will be a mentally-tasking thing to do for a
physician, as his code of conduct includes truthfulness.

However, there are also good reasons to not tell the patient about her sickness. It is a cultural
norm in Asian countries for an issue of health of a particular family member is discussed and
is done together by all the family members or the patient’s next of kin. This is especially true
to when the particular patient is an elderly and at times having certain diseases such as
dementia, Alzheimer’s disease or Parkinson’s disease, being unable to make a sound
judgment of his or her own condition. An good argument against telling the truth involves the
emotional and mental state of the patient when she hears about the word “tuberculosis” As is
may be more detrimental to her emotional wellbeing when the truth is delivered to her, ( she
has a preconceived idea about the disease tuberculosis and will not be calmed by a few words
from her attending physician.

I will respect the son’s approach in this particular case and not to disclose information
regarding the patient’s condition to her unless she specifically requested so by the patient
herself As the patient in this case is not known to have suffer from diseases which will impair
her cognitive and decision-making skills, I will respect the patient’s intention and decision
whether she wants to know the truth about her condition or not. However, I will also explain
to her son that tuberculosis is no longer a “death sentence” as it is now considered a curable
disease and I will try my best to treat her mother.