a. When integrating hope, solidarity, and emotion, medical paternalism may be
justified in order to maintain the mental health of the patient. Gruman focuses on
the human relations between the patient and doctor, in terms of trust, empathy,
b. Goldman assumes that the doctor has scientifically based knowledge on the
different treatment options, and that the knowledge is freely available. Once
knowledge of outcomes, benefits, and risks are discovered and made available to
doctors and patients, how would it affect the patient’s decisions?
c. E.G. Apatient is diagnosed with Stage D colon cancer, after having a tumor
removed. Gruman and his superior, Keyes, can’t do anything about it, but still
recommends a course of treatment option. Keyes tells the patient that
chemotherapy is a viable option, but that it has some side effects that can be
suppressed. Keyes is expressing a hopeful and optimistic message. Through this,
he is expressing that he is well-intentioned and on the patient’side. However,
Gruman discloses the medical truth as the story unfolds, in that Stage D colon
cancer is rarely, if ever cured (TOTAL eradication, or remission, not occurring
within 5 years time). Chemotherapy in Stage D is a palliative, only slowing
malignant cell growth. At best, chemotherapy may gain one or two years of extra
life. However, this is a gamble, and the patient may just end up suffering through
her last years.
i. Is he lying, withholding the truth? Is it justifiable? However, how would
you communicate a poor prognosis to a patient? Keyes defends his
communication methods in that saying otherwise may seem brutal and
against the patient’s mental health. He is arguing for preserving solidarity
and mental health and emotion.
1. “For patients like Francis and Sharon, too much information is
overwhelming. Ignorance is bliss.” – Keyes.
ii. After Sharon realizes that Francis is not getting better, Sharon asks
Gruman what really is going on. Gruman comes clean and explains that
chemo is at best, a palliative. Sharon implores why this was not disclosed
at the beginning, and believes that the doctors did not tell the patients
because they weren’t smart enough to handle. Gruman feels shamed
because he knew that the patients enclosed their entire trust towards
Gruman and Keyes.
iii. Goldman would have said that the patients had a choice, and if they had
had this information, she might have planned her last few months
differently. d. The values at stake go way beyond autonomy and “effective treatment” and
actually includes trust, faith, integrity, the HUMAN relationship. He implores an
“honest” hope, not an exaggerated hope like Keyes communicated. He believes
hope is a powerful factor in whether or not a patient can defy the probabilities of
statistics and take an otherwise seemingly unsuccessful treatment.
a. Quenlin Case (arguably created the concept of medical ethics)
i. After a car accident, Karen is taken to a hospital, experiencing a coma.
After a few months, the doctors conclude that she is placed in a permanent
vegetative state. The parents ask that the doctors pull the plug. These
parents are conservative Catholics, and their doctrine states that Karen
should remain in her “natural” state, without life support. The hospital acts
paternalistically and denies the request, and the doctors (who have a
degree of power) claim that Karen is “alive” and pulling the plug would be
a violation of medical ethics. The doctors in the hospital are also worried
about being prosecuted for homicide. The New Jersey Supreme Court
reaches a verdict that supports the Quenlin family, in effect giving them
the power, backed by the law, which was held by doctors and hospitals.
ii. The Quenlin case involves a powerful shift of credibility and authority
from doctors and hospitals to patients and their families.
1. The authority is rightful power.
iii. Rothman makes the distinction between arguments and reasoning between
the individual relation (the patient and the doctor) and in context of the
law, inferring that this argument and form of reasoning is now a social
statement, something that affects all people, not just you and your doctor.
1. The law does not imply that whatever is law is ethical; it does not
change one’s mind, but changes power relationships.
2. The argument lies in how to apply the right of self-determination
and privacy into matters of choosing life and death for oneself and
for others who are not capable of making this decision. We must
decide how our rights apply, if they do, in certain situations.
iv. The Quenlin lawyer appeals to the right of privacy and the right to choose
between life and death as an authority of the family.
v. TheAMAargues that issues of life and death lie solely in the doctor’s