Book Excerpt: Physician Ethics in End-of-Life Care

The Oxford University Press blog is posting excerpts from the book, The Ethics of Surgical Practice: Cases, Dilemmas, and Resolutions. Last week's excerpt dealt with a case where an elderly patient's family has requested that the physician withhold information on the progression of his cancer. The authors discuss the various options available to the surgeon and the ethical obligations.

You have excised a pancreatic adenocarcinoma from your respected college biology professor, who is now retired and widowed at age 85. He returns for follow-up examination after 9 months. Laboratory tests and imaging confirm recurrence of the tumor, with widespread metastases. He is being treated by a psychiatrist for depression and mild dementia, but remains legally competent and maintains his own home. His three adult children, two sons and a daughter, are ardent in their request that you withhold the bad news from the patient. Radiation and chemotherapy are marginally indicated for palliation, but he will probably consent to the therapy if you refer him. The patient hasn’t asked you for results of the diagnostic tests. What should you do?

(A) Respect the family’s request. Don’t volunteer the information about prognosis, and refer for palliation.

(B) Ignore the family’s request. Tactfully tell the patient that his cancer has recurred, and seek his consent for aggressive treatment.

(C) Tell the patient only if he specifically asks about his prognosis and recommend palliative therapy.

(D) Dissemble and minimize the seriousness, even if he asks. Tell him that
some other doctors are going to mop up the remaining cancer cells.

(E) Tell the patient the truth. Provide him with appropriate referrals.