Mrs. Scott may have expectations about the surgery that are unknown to Dr. Lee and Dr. Parihar. Accordingly, option D (having Mrs. Scott discuss her reasons for wanting the surgery) is an acceptable first step. Option C (further explaining why surgery will not achieve Mrs. Scott's medical goals) is the preferred action.
Option B, performing the surgery, should be avoided for a number of reasons including the failure to foster joint decision-making. More importantly, physicians are not ethically obligated to deliver care that they do not think will benefit the patient. Option A—referring Mrs. Scott to Dr. Parihar—may cause her to think she is being abandoned by her physician and provoke feelings of helplessness. Option E should also be avoided at this point in the case. Although it may be necessary later, a more thorough attempt should be made to discuss the issues involved before Mrs. Scott's care is transferred to another physician or hospital.
Preferable: Option C
Acceptable: Option D
Avoid: Options A, B, and E