Ethics 101 – Patients Who Hide The Truth
In this series of posts we are examining the ethics behind medicine. This includes the entire ethical spectrum of behavior by doctors, patients, nurses, and the entire medical system. Here we present another case scenario about a patient.
A 36 year old man presents to his plastic surgeon for cosmetic deformity. He would like a rhinoplasty for his nose. This is something that he has always wanted done. His plastic surgeon asks him why he wants the surgery as he is a good looking guy who is fit with good self esteem. His surgeon asks him if he has ever had plastic surgery before. The patient says no. Thus the surgery is scheduled and both the doctor and patient agree to proceed.
During the surgery the surgeon finds significant scar tissue that clearly indicates a prior surgery. This circumstance significantly lengthens the surgery and complicates the surgery. Nevertheless due to the surgeon’s skill the surgery is successful.
Clearly this is a type of unethical behavior by the patient. One that could significantly increase the risks of the surgery for both the patient and the doctor.
Is this unethical? What if the doctor has a policy of not doing revision plastic surgery and this is the only way for the patient to get the surgeon to agree to do the surgery?
Maybe some of you are thinking that this is not a big deal. What about if the patient fails to disclose that he has HIV or Hepatitis C and the surgeon has a blood exposure or needle stick in the case?
I won’t go this far but some could argue that failure to disclose could be criminal if there were harmful outcomes because of that failure to disclose.
I would be interested to hear what readers think.
JC, MD
Dr. JC is a medical doctor who has a passion for health promotion and education.6 Responses
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I can give you a perspective from both sides of the fence. I am an RN, BSN that contracted Hepatitis C from a needlestick while working as an oncology nurse at the VA hospital. I was documented but very far back in the history and nowhere on the quickchart or recent history. On admission he had answered no when asked. I feel it is my obligation to tell ANYONE who is coming in contact with my blood that I have HCV. I have even requested nurses wear gloves when taking mine or starting an IV, etc. I have had extreme reactions in both directions. Those that act as if they don’t want to insult me by gloving and being “extra” cautious and those who have refused to touch me when they found out. I do think it is an ethical issue and we harbor personal responsibility to tell others and keep them safe also.
Perhaps a better question would be this: If the surgery was botched because of complications that arose as a result of the previous scar tissue, could the surgeon be held liable? Should they be?
Yes I think it’s unecthical behaviour from patient end becuase it may cause critical situation for Doctor.
Both doctor and patient must be held legally responsible for whatever they are hiding.
Not disclosing such information is a wrekless behavior from the patient.and i think DR s should make their clients fill a disclamer or a form that has contains DRSsquestions and patients answers and the patient answer these Q’s and to date and sign it and aknowledge s that this information is true ,if something hapens or it apeared that the patient lied, the doctor would not be held liable or sued for misparctice or negligence.in some operations patients should be Hiv and hepatitis or insuline tested.
I don’t think it’s unethical for the patient to put himself at risk by failing to disclose; what I would be worried about, ethically, is when the patient puts his doctor (or other health professionals) at risk by failing do disclose, as with the communicable disease example above.
I think it’s unfair to require a patient to disclose everything if the only person who would be harmed by the failure to disclose is himself. For instance, a patient may wish to avoid disclosing suicidal ideation to his doctor because he (rightly) feels he will be involuntarily hospitalized if he does; I think it’s ethical for the patient to avoid involuntary hospitalization by failing to disclose in this situation.