AMA Journal of Ethics®

Illuminating the art of medicine

Journal of Ethics Header

AMA Journal of Ethics®

Illuminating the art of medicine

Virtual Mentor. January 2005, Volume 7, Number 1.

Module 2

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Case 2.1: Respect for Patient Decision Making—Mr. Douglas's Choice of Treatment

Option Comparison

To assure that Mr. Douglas is aware of the likely outcomes of his choice, option A is preferable and is expressly supported by the Code because it addresses the potential shortcoming of Mr. Douglas's decision-making capacity, specifically, his understanding of the likely consequence of no treatment. In requiring Mr. Douglas to restate his medical condition, option A gives Dr. Kim the chance to explain the limits of lifestyle options on treating existing conditions and to correct any of Mr. Douglas's misconceptions.

Option C, asking Mr. Douglas to bring his wife into the conversation, gives him an opportunity to carefully consider how his decision will affect the people and life he values. Option D (getting a second opinion) is also an acceptable alternative that gives Mr. Douglas another opportunity to have the severity of his condition explained. Although this may not help him clarify his values, it may emphasize to him the severity of his condition.

Options B, telling Mr. Douglas he will die, should be avoided. This options ignores the uncertainty inherent in any medical prognosis. No physician can know that a patient in Mr. Douglas's situation will die without treatment in the next month, and stating so attempts to coerce Mr. Douglas.

Preferable: Option A

Acceptable: Option C and D

Avoid: Option B

Additional discussion and information

The people and events in this case are fictional. Resemblance to real events or to names of people, living or dead, is entirely coincidental. The viewpoints expressed on this site are those of the authors and do not necessarily reflect the views and policies of the AMA.