Week 1 Discussion: CASE STUDY Group 1

Case Study: Years ago, a physician was called to the emergency room of a rural hospital to see
the patient of a local physician who was out of town at a meeting. The patient was a 21 year old
married female, a senior college student. She was experiencing considerable abdominal pain. She
had previous acute lymphoblastic leukemia as a child. Treatment resulted in a complete
remission. Recently, she had relapsed and was again under treatment. A common side effect of
one of her chemotherapy medications was abdominal discomfort.
The patient's mother intercepted the physician before he saw the patient to let him know that the
daughter did not know of the diagnosis of leukemia and he was NOT to tell her. He asked her to
explain the situation further. She indicated that when the diagnosis was originally made, she kept
the diagnosis from her daughter. She requested the everyone involved in her care agree to tell the
daughter that her problem was an unusual anemia. Apparently, they complied. When the
leukemia went into remission, the mother considered this chapter of her daughter's life closed.
When the daughter fell in love, became engaged and made plans for a wedding, the mother did
not share the previous diagnosis with either the daughter or the fiance. When the physician asked
the mother why she had not made the disclosure, she responded "I had enough problems to deal
with and I didn't need any more." The mother asked where the physician lived. He replied and
she said "Oh dear! A number of my daughter's friends live in the near area. I'm concerned that
they will hear of her diagnosis from you." The physician was astounded and insulted.
The mother was preoccupied with the need to protect her daughter from the diagnosis of
leukemia and unable to recognize that the physician would be confidential with patient records.
Questions for your response:
1. If you were the physician, what would you have said to the mother when she told you NOT to
tell the daughter?
2. If you were the physician, what would you have done in this situation? Would you have told
the patient about her leukemia? Why or why not?
3. Can you think of a few reasons why the mother may not want to share the news of the
diagnosis with the daughter?
4. At what age dose the patient have the right to know her diagnosis?

1. If I were the physician in this situation, when the mother told me NOT to tell the
daughter about her leukemia, I would empathize with her concerns and try to engage in a
compassionate and understanding conversation. I would explain to her that although she
still wants to protect her daughter my job as a physician is to represent her “adult”
daughter. At this point in her life the daughter is in charge of her medical care and
 deserves to know the truth about her diagnosis. At this point maybe a social worker
would need to get involved and help with the emotional distress this will cause both
parties.

2. I would tell the patient about her diagnosis for these few reasons
o As a patient, the 21-year-old has the right to know about her own medical
condition.
o Revealing her past diagnosis of leukemia may have a significant impact on how
she makes further medical decisions in her future.
o Physicians have an ethical obligation to be honest and transparent with their
patients, respecting their autonomy and promoting their well-being.

3. The mother’s decision not to tell her daughter about her diagnosis I feel, truly comes
from love. She wanted to protect her daughter at a younger age and shield her from the
emotional distress a cancer diagnosis comes with. At this point if she tells her daughter
about her previous diagnosis this will more than likely ruin the trust the mother has with
her daughter.

4. In this case, the patient is 21 years old, which is considered an adult. Therefore,
ethically and legally, she has the right to know her diagnosis. In many countries, once a
patient reaches the age of majority (typically 18 or 21 years old), they are legally
considered adults and have the right to access their medical information, including their
diagnosis, without parental consent.