You have a patient who has recently been diagnosed with myeloma and he is ing treatment options with you. You are the full-time employee of an facility 1g1 by a managed-care plan and you have recently received writtentions not to bring up subjects such as bone marrow transplantation in myeloma patients. The reasoning was that they are outrageously expensive and do not cure disease, although it may extend survival. The data that they extend survival are entirely conclusive. ln addition, in a private meeting with the medical director,you have been told that the expenditures per patient load of care of each of the would be examined yearly to determine which physician would be promoted.
What do you do?
Fully inform tl.re patient about the risks and benefits of bone marrow transplantation.
Refer your patient to an oncologist to have this discussion. tlransfer the patient to another primary-care provider.
Advise the patient to file suit against the managed care plan.
Give the patient treatment with melphalan or thalidomide which both able therapy.
f. Inform the patient about bone marrow transplantation if he asks you about it.
Explanation:
(a) Fully inform the patient about the risks and benefits of bone marrow transplantation,
Your primary duty is always to the patient. One of the unique elements of the physi_ cian/patient relationship is that its ethical boundaries transcend ordinary rules of the workplace and institutional rules. As such, you cannot withhord information from a patient if that information may lead to benefit for the patient. ln order to make an “informed consent,” the patient must be fully informed. The patrent cannot be fully informed ifhe has not heard ofthe options. It is not appropriate for lou to back away from educating your patient by transferring care unless it is for an area outside vour expertise. There is no need to encourage litigation under any circumstances.
It is not ethical to tell a patient about a potential therapy only if he asks about it. It is our duty to inform him. "Gag orders,’ preventing the education of patients about treatment options are always wrong. The patients cannot haye autonomy over the choice of treatment of their body if they are not aware of the options. Beneficence to the patient always outweighs institutional directives