Yoo-Seock Cheong, MD, PhD iProfessor in the Dept. of Family Medicine, Medical Ethics j



  Case1) 36 years- old, Female

  She was pointed out the abnormal mass in her kidney. The malignant tumor was s
  uspected. The patient was afraid of the operation scar remains. But, the surge
  on did not tell the patient about the operation scar. The patient told to the
  medical student of her fear about the operation scar.
  So the medical student asked the surgeon if the surgeon try to use special tec
  hnique not to make big operation scar or asked the plastic after the main oper
  ation. But the doctor said to the medical student, gShe doesnft need treatme
  nt of operation scar, because she is not a young lady. She has already got mar
  ried, and has children.h



  Comment; I think the surgeon has to respect patient's preference. Modern medical ethics tends to emphasize more patient's autonomy rather than other principles. Especially cosmetic thinking of
  female patient' body may be totally diffent from doctor's. The surgeon should find more skillful and unscarring operation method for her if the operation risk is not too much.



  Case2) In the training in ER rotation. Some ER doctors treat the alcoholic pat
  ient or the patient who committed suicide painfully not to do that kind of beh
  avior again. Is that right thing?



  Comment: That kind of procedure is ethically not good choice. That  commits "Do no harm" & patient's automony principle. ER doctor has to persuade their patient in other reasonble ways and
  introduce to other specilists, such as psychiatry.



Tom TomlinsoniProfessor in Medical Ethics,Michigan state Univrsityj



It is good to hear from you again. I'm inserting some comments after each of these cases



Case1) 36 years- old, Female

She was pointed out the abnormal mass in her kidney.
The malignant tumor was suspected. The patient was
afraid of the operation scar remains. But, the surge
on did not tell the patient about the operation scar.
The patient told to the medical student of her fear
about the operation scar.
So the medical student asked the surgeon if the
surgeon try to use special technique not to make large
operation scar or asked the plastic after the main oper
ation.
But the doctor said to the medical student,gShe doesnft
need treatment of operation scar, because she is not a young
lady. She has already got married, and has children.h

COMMENT: First, I would say that the surgeon's comment assumes too much-- without having talked to the patient, he is in no position to know what the patient's reasons are for being concerned about the scar. So the first thing that needs to happen is for the surgeon to talk directly to the patient about her concern, and to offer to do his best to minimize scarring. Even if he can't promise a cosmetically beautiful result, he should at least acknowledge the patient's worry, and should be honest with her about what she can expect to see when the operation is over. Otherwise, the patient may end up feeling dismissed and disrespected, and this could affect her trust and confidence in other physicians involved later in her treatment.



Case2) In the training in ER rotation. Some ER doctors
treat the alcoholic patient or the patient who committed
suicide painfully not to do that kind of behavior again.
Is that right thing?

COMMENT: I'd say no. Either they do this with the idea that somehow this will cure the patient of alcoholism or suicical tendencies; or they are doing it because they think the patient deserves to be punished for doing something wrong. The first reason has no basis in fact that I'm aware of-- the causes of alcoholism or suicide are not so simple. The second reason is also unacceptable. First, it assumes that alcoholic or suicidal behavior is entirely within the control of the person, and so something they can be held responsible for doing. But very often, these behaviors are not easily controlled (this is part of the reason they are properly thought of as diseases, or symptoms of disease). Second, for doctors to make themselves agents of punishment betrays the most fundamental value of medicine-- to make the patient's welfare one's first concern.