Today, patients and their families are involved in processes and choices surrounding medical care. Yet the requests or demands of a patient may put his or her doctor in an ethical quandary. For example, a doctor may have to choose between keeping the diagnosis of HIV infection confidential or reporting it to public health officials to protect the health of other persons who might have been exposed to the infection. The doctor must decide how to balance his or her primary responsibility to the patient with obligations to other persons in society.
For their part, patients and families should be aware that different physicians, based on individual values and reasoning, may respond differently in similar situations, just as different families respond variously to the same situation. Family members should listen carefully when a doctor makes a recommendation and invite the doctor to explain the rationale for the approach if one is not forthcoming, Kaldjian said.
When a patient rejects a doctor's recommendation for seemingly ethical reasons, it may be that those involved simply have not conversed with each other enough to understand each other's thinking and reasoning.
"Physicians are often unsettled by patients who refuse what the physician believes to be a good recommendation," he said. "If that recommendation is made too quickly and not accepted, there can be conflict, and the physician might think there's an ethical problem. In fact, it may be that the exchange was too rushed and that real dialogue has not yet happened."
In other instances, a physician may believe an ethical issue is at hand, when the need for additional facts may really be the issue.
"If a family rejects a physician's recommendation, he or she should review the medical literature and see if all the options were considered," Kaldjian said. "A thoughtful p
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Contact: Becky Soglin
becky-soglin@uiowa.edu
319-335-6660
University of Iowa
10-Feb-2005