1. The Argument for Disclosure

2. Dilemma #1 According to the law, a physician must obtain informed consent prior to performing a procedure. Consent is obtained after telling the patient or the patient’s representative the following: * diagnosis * nature of proposed treatment * name of the procedure * description in layman's terms * risks associated with that treatment * alternatives and associated risks * risk of no treatment In the story, the problem the physician deals with is a family wishing to filter the information that the patient receives. The family may wish to do this because they do not feel that the patient will make wise choices or they may wish to avoid any stress or depression that may come as a result of negative information. The physician must determine if filtering is in the patients best interests or not. The physician must also determine if filtering is a choice even available to him.

5. Informed Consent

6. Veracity

7. Autonomy

8. Accountability

9. Pillars of Disclosure Pt. Self-Determination Pt. & Family Cooperation Hope & Closure

10. Since the early 1900’s there has been a growing belief in the patient’s right to know and the opportunity to make decisions related to their own care. The creation of “informed consent” was the result of the 1957 Salgovs Leland Stanford Jr Board of Trustees. In awarding judgment to Salgo, Judge Brady’s pronouncement were, “A physician violates his duty to his patient and subjects himself to liability if he with holds any facts which are necessary to form the basis of an intelligent consent by his patient to the proposed treatment... In discussing the element of risk a certain amount of discretion must be employed consistent with the full disclosure of facts necessary to an informed consent. Katz J. The Silent World of Doctor and Patient. New York: The Free Press; 1984. Pt. Self-Determination

11. When one member of a family has cancer, the whole family is affected and, in fact, psychologists consider these family members to be "secondary patients." Cancer affects an entire family, not only because there are genetic links to cancer and cancer risk, but because when one member of a family has cancer the whole family must deal with the illness. (American Psychological Association) Just as there is a healthcare team, the family and patient should be considered a team. A team can be compared to rope. An individual alone, or a strand of rope alone is not very strong. Take all the strands, or all of the family together, and the rope is very strong and do much more. Pt. & Family Cooperation

13. Patients who were not informed of the diagnosis tended to be more anxious and at times, felt desperate.

14. Families of informed patients felt that they were in a better position to care for the patient.

15. Diagnosis disclosure in cancer is also correlated with improved symptom control and patient satisfaction with care.

16. Therapeutic decisions can be discussed with the patient and carried out with his or her full consent and knowledge.Hope & Closure

18. The physician would feel that he is continuing to gain his patient’s trust – further developing the team concept of the patients care.

20. Family would be an integral part of the patient’s decisions regarding care.

21. Family would be educated on the disease process, treatments, and ways that they may help their loved one.

23. The patient would have hope as his knowledge of the disease process increases. The patient stating he would kill himself if he had cancer shows ignorance that should be corrected.