Module 3

In this activity, you will discuss and consider elements of the doctor-patient relationship and professional responsibility with respect to truth telling and trust.

•Read the following before proceeding to the activity:
?Munson text: pp. 137-154; 170-174.
?AMA Opinion 10.01 - Fundamental Elements of the Patient-Physician Relationship
?Principles of Medical Ethics. (2001).
?Schwab, A. P. (2008). MEDICINE AND SOCIETY, The Patient’s Piece of the Informed Consent Pie. Virtual Mentor American Medical Association Journal of Ethics, 10(8), 527-530.

Read the following case scenario and respond to the discussion prompts that immediately follow:

Six months ago, Mrs. Plicibo, a 42-year old patient with Stage IV non-small cell lung cancer and an inoperable brain metastises was referred to Dr. Rogue by her Oncologist, who had exhausted all other treatment options. Dr. Rogue is known as an expert herbologist, having spent years studying alternative natural medicines used around the world.

Dr. Rogue prescribed the standard therapies of anti-seizure medications and steroids to reduce brain swelling, but he also offered her the option of trying a ‘secret’ natural supplement that he had discovered on his latest trip to the Orient. Explaining that the treatment would require a weekly injection, but that he would cover the cost, Dr. Rogue took considerable time explaining to Mrs. Plicibo that he could make no guarantees as to the effectiveness of the treatments, other than the fact that other patients had reported positive results along with no adverse side effects. Desperate for a chance, Mrs. Plicibo had tearfully agreed.

Today, after examining Mrs. Plicibo and reviewing her recent lab results, it is clear that her condition is deteriorating rapidly, despite the apparent improvements she has made over the past few months. "I just don’t understand," sobs Mrs. Plicibo, "I was doing so well with the shots—it was like a miracle. Isn’t there something more you can do?" "We can try upping the dose for the next week or two, Mrs. Plicibo, but if there is no improvement, I am afraid we will have to discuss some options and support services to make things easier and to keep you comfortable." "Please don’t tell me that, Dr. Rogue. I think this will work!" Promising to give it a try, Dr. Rogue leaves to get his assistant. Taking her aside he whispers "Molly, please prepare the ‘hope shot’ for Mrs. Plicibo - and of course - do not tell her that it is only water!" "Of course not, Dr. Rogue," smiles Molly. "Why mess with something that is working!"

Discuss the following:

Given the positive outcome over the last few months, and Mrs. Plicibo’s insistence that Dr. Rogue continue the shots, was Dr. Rogue’s treatment ethical? Why or Why not? Remember to justify your response using the ethical theories, topics and principles we have studied throughout Module 1-3.