POST EXPLANATION AND REASONING

I wanted to explain my last post “Protecting or Withholding.” I wanted to see what kind of response I would get relating to the topic of withholding medical information and their POA’s. Just to let everybody know the first part of the post is what I am currently involved with. The last part is based on what I have seen during my medical career. Unfortunately withholding medical information from family members because they feel they want to protect them from awful news happens quite a bit in this country. This brings up an ethical dilemma I want to discuss. For your information I did change some things about my current situation to maintain confidentiality of everybody involved. I do not want anybody I deal with on a day to day basis attach my post to my patients. But the content of the situation is still there as well as the ethical dilemma I am facing with the POA.

I am going to give you two scenarios which have the same outcome. Take my post and the POA’s wishes. She did not want her father to know he had lung cancer because she believed it would cause him to decline faster and give up. Even after many conversations of trying to get her to tell him she still told me she did not want him to know. As the medical provider I believe it is the right of the patient to know their medical condition and test results in spite of the POA’s wishes. The POA found out I had told him, her father declined as expected but she believed he passed away sooner because of the news. She hired a lawyer to sue because of mental anguish and unnecessary stress of her father dying of a terminal disease because she believed he would have lasted longer if he did not know he was dying of cancer. Can’t happen? In our sue happy society and lawyers and judges taking cases as silly as an overweight man suing a fast food chain because he felt it was their fault he was fat? Give me a break. They are out there and everybody knows it.

Scenario #2. Take my post’s scenario and after many conversations of getting the daughter to tell her father he had cancer she still did not want him to know. As the medical provider I abided with her wishes and tried to make her father as comfortable as possible during his last days. During her father’s last days he became more confused and lethargic and unable to understand what was happening. He was considered no longer competent to make his own medical decisions at that point and the POA was needed for any direction with his care. After his death the father’s sister found out he did not know his test results and he had cancer. She did not keep in contact with her brother’s daughter on a regular basis. Even after many conversations with the POA she could not understand why her brother did not know he was dying from cancer. She felt it was his right to know even though his daughter verbalized her wishes. This caused her mental anguish because she did not know her brother was ill and lost the last opportunity to see her brother for the last time. She hired a lawyer to sue because of withholding medical information and mental anguish because she could not see her brother before his death.

There is a difference between what people say and what they do. Many people are not prepared for the stress of losing their loved one and make decisions other than what they knew were their wishes. Maybe this is protecting them or maybe denial because they do not want to deal with the situation at hand. I don’t know how many times I have seen a living will in place that stated the patient did not want CPR if their heart and breathing stopped. The family members were aware of the wishes and were satisfied with the decision at the time the living will was written. Then their mother/father/brother/sister’s health declines and they jump in and say they want everything to be done to save them including CPR. That is their right to change their minds but what about the wishes of their parents? I just dealt with a situation a couple of months ago when a father’s health was declining and the son, the POA, wanted everything done despite what the advanced directive he signed stated. He threatened to take him in his vehicle and to the emergency room as he was yelling at the staff because the facility did not have the medical supplies needed at the time.

Now I will talk about my situation at hand. I professionally and personally do not believe in withholding medical information. I will speak with the POA on a regular basis trying to get her to tell her father about his chest CT and the results. I believe after the "shock" of the news maybe she will realize he needs to know. But if, after many attempts, she still did not want to tell him I would discuss the test results with him and ask him what he thought. I believe he knows his health is failing. I believe he knows he is dying. I believe it is his right to know despite what the POA wished. From my experience the patients knows a lot more than we give them credit. Every conversation is documented and with my State's patient bill of rights, it is their right to know their medical condition. Not every medical provider believes that.

I appreciate the input and comments on this post. I am dealing with this slippery slope medical dilemma. A statement that is said around the medical community today is: “We are treating the lawyer, not the patient.” How sad is that? Any comments appreciated about this and maybe your personal experiences.