Thursday, September 11, 2008

Answer to the ethics question and a bonus ethics question (lucky you!)

Alright, ladies and gentlemen, here is the 'answer' to the ethical question. I use the term answer loosely, because in this article it basically says that other institutions have opted for the opposite route. So, this basically means that it is up to each institution to make the decision. So I hope the answer to my board question, should I get one, is any choice. The quotations below were taken from Urology Volume 64 , Issue 3 , Page 590 "Misattributed paternity in a living related donor: To disclose or not to disclose?"Douglas W. Soderdahl, Danny Rabah, Thomas McCune, John Colonna, Roland Frenc, Edwin Robey and Michael D. Fabrizio,

Arguments for disclosure:
"Arguments for disclosing paternity are these. First, each patient must be treated as an autonomous agent who can make informed decisions, based on all the information available. In this case, the patient has a right to his test results and their interpretation. This allows for true informed consent when the patient is being counseled.

Second, to withhold the information, the physician acts in a paternalistic manner, whereby the doctor makes a value judgment as to how a patient might handle the information. Thus, the perceived potential beneficence and nonmaleficence of how information will be handled is valued above that of patient autonomy. The decision for nondisclosure is based entirely on hypothetical negative outcomes (ie, family break-up), which may or may not come to fruition.[3]

Third, one of the duties of the medical profession is to tell the truth, and although nondisclosure might not be on par with lying, deception, or misrepresentation, it still has ethical consequences. The truth has a tendency to become disclosed eventually and might irrevocably damage the patient-physician relationship when it does.[6] In addition, there might be legal ramifications if the information is discovered in the future under other circumstances.

Fourth, disclosure of the information allows the son to clarify his genetic heritage. His medical family history would not include that of his father or his father's relatives. His future health and life insurance might be affected by this information."

Arguments for non-disclosure:
"Arguments against disclosing paternity were as follows. First, by revealing the paternity information, there is a potential for irrevocable harmful effects on the emotional well-being of each patient and the family unit as a whole. Even though there are no legal or ethical obligations owed to the mother, this information is certainly sensitive to her, and her reaction must be considered as well. Ultimately, the information could prevent the potential transplantation and result in a break-up of the family unit. The “best” result in this case would be a successful transplantation and maintenance of stable family relationships.

Second, by informing both parties of the HLA typing results, one could argue that the physician breaches the confidentiality of each individual's findings. Each patient must give their own informed consent, even though the procedures are intimately related, and there is no absolute right to the other individual's test results even in the context of transplantation.

Third, because the testing was done solely to evaluate donor/recipient compatibility, one could argue that the unsought paternity implications are irrelevant. The son was still a suitable match for his father, and the results would not affect the transplant procedure. In that a similar situation could arise from simple ABO typing, eliminating HLA typing will not prevent situations like ours from occurring."

And what did they do?

"After much deliberation, we elected to inform the father, son, and mother of the results of testing. The paternity implications of the results were presented in as supportive a manner as possible. After a 2-week period requested by us, both patients consented to the procedures and underwent successful operations. At the time of the disclosure and in follow-up, the donor and recipient were both adamant that we did the right thing in informing them of the result and felt that it should always be done. Importantly, the family remains intact."

Here is another question. Is it ethical for the newly promoted Associate Dean for Curricular Affairs to change the long standing rule that states that if something was not presented in lecture, that it wouldn't be on the test?

How about if I tell you that she is also a professor?

How about if I tell you that she is also going to try to pass the rule that it is mandatory to purchase the books for each class?

How about if I told you that she also wrote the book for the class she teaches?

Perhaps a conflict of interest?

Stay tuned for the 2nd year students to take their first test from her. There is talk of a 2nd year student mutiny should she put a question on there that wasn't from lecture. Med school is so exciting. I hope the security guards have their riot gear.


  1. So, the Jerry Springer episode of "Who's Your Daddy?" didn't destroy the family, huh? Good to hear; however, I still like the more holistic approach taken by the non-disclosure panel. Keep it simple.
    So, you have your first pseudo-sleazy prof? It's reassuring that the 2nd years are on to her, and that they, like you, are also probably putting dirty dishes in their refrigerators (and perhaps toilet paper in their freezers!)but that they are also remembering to maintain their wider focus on ethics and integrity. Board questions are not the only places they'll have to make choices, and I'm reassured that most of your gunners see this. Mutiny and petitions sound great to me...sometimes they actually work, and they almost always help blow off steam...but then I grew up in the 60s!

  2. Did somebody say mutiny? I'm in!