Sunday, February 8, 2009
Death or Impotence -- Tell the Truth
I favor the full Kantian Categorical Imperative approach against paternalism, there should be 100% informed consent with Mr. Williams. Dr. Kramer should tell the truth and have a serious discussion with Mr. Williams about the small risk of temporary impotance from taking the antihypertensive medicine. The good doctor is showing respect to Mr. Williams by telling him the truth!
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Couldn't agree more. As a patient, how would you feel if you became impotent after taking the drug and when you came back to your doctor, she said, "Oh yeah, that is one of the possible side effects. I just didn't tell you about it." You might feel relieved at first, now knowing that the problem is reversible. But knowing that this was a possible side effect from the start would have prevented all of the grief and anxiety you experienced due to the sexual dysfunction.
ReplyDeletePlus, I would generally feel offended that my doctor withheld this information, deciding on her own which factors in my life are more important. I would not only be scarred and distrust this physician from now on, but probably begin to distrust all medical professionals.
I believe that withholding this information would violate the hippocratic oath of "do no harm". Physicaly, the patient would get better but what about his psychological harm that this lack of information would cause on the patient. psychological stress like that could affect his blood pressure and emotional state more than not taking the drug at all. Furthermore, if Doctors, as in the deliberative model are supposed to be "our friends and advocates" and help us decide on our value system and overall well being, how is withholding such important information to a man having a good deliberative relationship?
ReplyDeleteThe FDA now requires all food to list all ingredients regardless of their harmful side effects. Why in this society, is it illegal to withhold information on our food but it is seemingly ok for a doctor to withhold information from us just because they think it would possible hurt us. I agree that the Dr. Kramer should reveal all information and then let her patient decide what ultimately will only affect his life.
I respect the direction of the class with regard to allowing Mr. Williams the autonomy to make a fully informed decision about his health, but I feel the need to play the other side a bit...
ReplyDeleteLet's look at the benefits, the diurectic (hydrocholorthiazide) has "a long history as a cheap and highly effective remedy." Did you know that hypertension can lead to heart attack, stroke, kidney failure, and untimely death? Don't the benefits outweigh the risk of only 3-5% of males developing (reversible) impotence? Why burden someone who already has so much going on (newlywed, young step-children, possibly limited income (he was being seen in an inner-city clinic) with information that might alter his thinking and potentially - his cure or at least the ability to better manage his high blood pressure, over something like reversible impotence? Impotence is not deadly and perhaps if Mr. Williams does become temporarily impotent, he and his wife might creatively enjoy other ways to share their intimate lives that wouldn't have been explored if he had not lost his erectile function!
If Mr. Williams is given full disclosure and chooses not to take the cheap and practical drug offered by Dr. Kramer, his high blood pressure could cause sustained impotence anyway - then what?
Dr. Kramer would have done what is impermissible by Kantian standards if he failed to disclose relevant medical information to Mr. Williams with the intention of using Mr. Williams as a mere means to an end. It seems to me that, in principle, it is possible to conjure a maxim such that would make Dr.Kramer's not disclosing some side-effects permissible.
ReplyDeleteThe historical Kant may have been opposed categorically to all forms of deception; but that does not necessarily mean that his moral theory rules out all forms of deception (it might after all, but it's not obvious to me).
Lebenswelt, I think you are absolutely correct in saying that “Dr. Kramer would have done what is impermissible by Kantian standards if he failed to disclose relevant medical information to Mr. Williams with the intention of using Mr. Williams as a mere means to an end.” I believe that this idea, using a patient as a mere means to an end, encompasses a crux of the debate against paternalism.
ReplyDeleteBy viewing persons as having an intrinsic worth and treating them as ends in themselves, a doctor must be upfront and honest, allowing the patient the ability to make medical decisions for themselves. This is incompatible with a paternalistic doctor-patient relationship.
While reading the case study provided, I completely agreed with Dr. Robert Black. I felt that Dr. Kramer was really making a big deal of absolutely nothing in this case. Though I can understand why some may consider withholding information to be a paternalistic act, I believe that the doctor will cause more harm by telling the patient about the temporary impotence.
ReplyDeleteI strongly believe that the Hawthorne effect would probably cause impotence more than the drug itself! The risk is so minimal (only 3-5%) that it does not need to be addressed, unless the issue arises.
If Dr. Kramer is having serious internal conflict about how to approach the situation, then I believe it would be in her best interest to choose option b): casually mention the risk, but only in passing along with other minor risks
My feeling is that she is making the issue much larger than it is. I believe that alone could be picked up Mr. Williams and cause him to have anxiety about taking the drug!