Ethics in Theory versus Ethics in Practice
Ethics is always challenging but it is particularly intense and, at times, heartbreaking in medicine. During medical school, when our ethics professor presented cases for the discussion (e.g. whether or not a patient should undergo an experimental treatment without assurance of life, therapeutic abortion, euthanasia and assisted suicide), our class always had heated conversations. Understandably, even if most of us were applying the same ethical principles, we each had different approaches to the issues in medical ethics due to differences in context. At least we were able to speak out and have lively discussions.
Although the cases are similar in actual medical practice, the reactions and responses are quite distinct. In discussions of concrete cases by the medical team, there are long periods of silences, when each member tries to gather his/her thoughts and come up with an acceptable response in the background of unease of holding the key to life or death. Oftentimes, each of us ends the ethics discussion with a disturbed face, a lined face and a heavy heart.
Medical Ethics: HIV/AIDS and disclosure
Among the ethical situations in medical practice I have encountered, one of the things that come to mind is the issue of HIV/AIDS and disclosure. One of the core principles in medical ethics is the Principle of Autonomy. Under this principle, a patient has the right to decide for himself/herself, including whether or not to disclose his/her condition.
Our hospital had a patient who is a lawyer, has a girlfriend and has HIV/AIDS. He was dying from PCP (Pneumocystis carinii pneumonia) but he refused to disclose it to his family because of shame. He belonged to a family of lawyers.
Prior to getting intubated, he wrote a letter informing the medical team that any means to hide his diagnosis should be done; otherwise, he would sue the medical team. The medical team agreed to keep his diagnosis a secret. Each time his lawyer brothers and parents asked about his diagnosis, the standard answer was severe pneumonia. It came to a point when the patient’s family threatened the medical team for malpractice, saying “What kind of doctors are you? Are you that incompetent that you can’t even treat a simple pneumonia?”
The patient’s stay in the hospital was relatively brief. Even to his last moment, the medical team kept silent about his AIDS. The medical team continued to face the threat of a lawsuit.
Fortunately, prior to his death, the patient agreed to reveal his diagnosis once he dies. In the end, when the medical team talked to the family, the family stated that they had an inkling of his condition; they just wanted the doctors to admit to it.
What about the patient’s girlfriend then? Although some states require the patient’s partner to become informed regarding the patient’s HIV/AIDS condition, other states don’t. In this case, the law fully extends the right to disclose to the patient. Should the medical team also inform the patient’s girlfriend, who is at risk of the disease?
Further questions to think about in this case are as follows:
If the girlfriend was of no relation to the physicians, it is not the duty of the physicians to inform the patient. What happens if the girlfriend consulted one of the members of the medical team for pneumonia? Should the girlfriend be informed that she is at risk for HIV/AIDS and should be tested?
At this point, a review of the patient-physician relationship is merited. The physician who treated the patient with HIV/AIDS now treats the girlfriend. When a former patient dies, does the principle of autonomy no longer hold true? On the other hand, is it not the duty of a physician to keep the current patient’s well-being at the fore?