Health Care Ethics

Case Study

Failure to diagnose

Presenting Ethical Dilemma:

A Physician Assistant request an Ethics Committee to help decide if a
patient should be told that his terminal lung cancer was discovered two
years ago, but not followed up for treatment.

Medical Indication:

A 30 year old married father of four children was just diagnosed with
terminal lung cancer. He was told last week that he has 6-9 months left,
if perhaps a few months of chemotherapy and radiation are tried. The
tumor is an Adenocarcinoma but too large for surgery since it has
invaded thoracic structures.

He asks the Ethics Committee if the patient should be informed that a
failure to diagnose had occurred.

Patient Preference:

The patient has both capacity and competency to decide, but we have no
way of known if he would want to be told.

Quality of Life:

The ethical conflict is what the information about failure to diagnose
will do to his remaining life. The patient’s primary nurse tells the
Committee that it would destroy his morale and will to live. The
Physician Assistant believes the patient should be told, but isn’t
sure what it will do to the patient and his family.

In a legal case (Natason vs. Kline, Kansas 1986) the rule was that a
Physician may withhold information based on “sound medical judgment”
if it will detrimental effects on the patient.

Contextual Issues:

The attending physician who failed to follow up two years age is no
longer on the hospital staff. He could be located however.

The attorney on the Committee states that if the patient is informed he
can and probably would file a malpractice claim. Such a malpractice suit
could injure the physician’s career and the hospitals reputation.
However, it could win financial support for the patient’s family
survivors.