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Cassandra Bourdeau
HS 2050
Jeffrey Zealley
May 2, 2016

Ethical case- Withholding information from a patient due to current state

In this ethical case, we will be discussing an anxiety patient needing to get hernia surgery
right away. Due to her anxiety, she is a very nervous and barely gets through the consent to
perform the surgery. The anesthesiologist is now questioning if she should tell the patient all the
risks of general anesthetics due to her anxiety of dying during the surgery. The anesthesiologist
has to take consideration if she can use therapeutic consent without violating the patient's
autonomy.
The right ethical choice is to talk to the patient and see what exactly her concerns are if
her concern is that she is afraid of not waking up after the procedure due to general anesthetic
then her preference might be to use a regional anesthetic. The anesthesiologist may not have
taken this option into consideration due to her preoperative diagnosis of anxiety. Just like the
anesthesiologist did, we have to look at all the options and see if telling the patients all the risks
is the right choice. In these next few paragraphs, the paradigm boxes will be used to analyze the
ethical choice of this case. Also another option side and its strengths and weaknesses.
Medical indications are that the patient has very high anxiety and is on duloxetine to help
control her anxiety disorder. Mrs. Chen has been experiencing extreme pain for the last three
months when it comes to lifting objects and straining. Her primary doctor referred her to a
surgeon for further evaluation. The surgeon determines that she needs inguinal hernia repair soon

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as possible. Mrs. Chen had become very worried about dying during surgery and that she barely
had made it through the surgery consent. Now the anesthesiologist is afraid of causing more
anxiety telling the patient about the risk of the anesthetics used during the procedure. From
research on hernias, the only way to get rid of one is surgery. No exercise or therapy makes it go
away.
Mrs. Chen wants the surgery and gave consent but during the consent for the surgery, she
was very anxious and worried about dying. The anesthesiologist needs her consent for
anesthetics during the surgery. The anesthesiologist is worried about giving Mrs. Chen the full
risks since Mrs. Chen is very nervous about the surgery. Anxiety disorder affects 80 percent of
people in the preoperative period. High levels of anxiety have been seen to affect the
postoperative course. It heightens postoperative pain and infection risk, wound healing isn't as
efficient and long-term behavioral and cognitive changes have occurred frequently amongst a
majority of patients. The patient has signed consent for the surgery to be done so, therefore, they
were aware of the risks that came along with agreeing to surgery but the patient hasn't heard the
risks of general anesthetics. The ethical dilemma here was to tell her all the risks or to use
therapeutic consent like stated above. Not knowing all of the patient's preferences due to the case
is very hard to analyze this case. The patient had already signed consent for the surgery. So we
know the patient wants the surgery and that she wants to get better but she doesn't state what
preferences she wants in aesthetics since the anesthesiologist is debating to tell her the risks and
etc.
In this ethical case, the quality of the patient's life can be at risk if a hernia doesn't get
taken care of. Worst case scenario from not getting the hernia repair done the strangulation of a
hernia can occur and can lead tissue death and infection, which can cause more serious problems.

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The patient will continue to be in extreme pain and still have difficulties when lifting objects. A
hernia does not get better over time, nor does it go away on its own. No exercises or therapy can
make it go away so, therefore, the surgery is the only way to get rid of it. The patients mind isn't
completely clear due to her high anxiety of the procedure. To get Mrs. Chen out of pain the
anesthesiologist needs to give her all the options that are available so the patient can feel better
and return to her life without being in pain every day. The anesthesiologist was willing to not tell
the patient the full risk of general anesthetics and therefore potentially causing less anxiety on
the patient and making Mrs. Chen more willing to go along with the surgery. But the patient
deserves to know every risk if that is what they want. Any patient is allowed to tell the doctors
what he or she wants and doesn't want to hear when it comes to risk or any information about a
procedure.
Legal issues come into play on this paradigm box. The professional anesthesiologist is
debating to share or keep information from a patient due to an anxiety disorder the individual
has. Patients have the right and it is their right to know everything about their health and all the
risks that come with procedures or methods to fix the problem. The anesthesiologist had their
own opinion on wanting to keep the information from the patient due to wanting the patient to
participate in the surgery still so the individual could get back to their life without being in pain.
Conflict of doctor and patients opinions have always been an issue in the healthcare field.
Doctors think they know what is always nest for patients but at times, the patient actually knows
what is best. In this situation, the professional should have elaborated with the patient more and
let the patient know what exactly they needed to talk about and some of it may not be good.
From doing this the patient may decide to talk about certain things of the situation and decide to

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keep the others information from being said and an understanding of what the patient wanted
would have been reached with no crossing or violating of the patients autonomy.
Other sources stat that Withholding medical information from patients without their
knowledge or consent is ethically unacceptable. Healthcare professionals should encourage
patients to specify their preferences regarding communication of their medical information,
preferably before the information becomes available. Also, they should honor patient requests
not to be informed of certain medical information or to convey the information to a designated
proxy, provided these requests appear to genuinely represent the patient's own wishes.
All information needs to not be communicated to the patient immediately or all at once;
doctors at first should assess the amount of information the patient is capable of receiving.
Delaying certain things for a minute may allow the patient time and space to elaborate on the
subject at hand. The healthcare professionals should continue to check the patient and offer the
choices for the current situation when the patient is able to decide whether or not to receive this
information. This should be done according to a definite plan so that disclosure is not
permanently delayed.
The other option here was to not tell the patient at all of the risks and causing more
anxiety to the patient would have been avoided. The surgery would not have gone as planned
along with the general anesthetic that was reached to being the best suit for the current patient do
to preoperative screening and such. The surgery may have been a success and the anesthetic as
well without the patient knowing the risks but if something went wrong and patiently found out
didn't sign a full consent do to the certain risk, legal concerns come into play.

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In conclusion, the right ethical choice, in this case, is to consult the patient on his or her
concerns and try to address them accordingly. Communicating with a patient is a very important
key to a successful patient-healthcare professional relationship. Communicating concerns and
solutions is a part of the plan and take steps to make a final decision. Also, the patient needs to
lay it all out the first thing about what certain thing he or she want to know and don't want to
know about the risk or any information of the current problem at hand.

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Resources
American Medical Association. Opinion 8.082 - Withholding Information from Patients, n.d.
Retrieved from http://www.ama-assn.org/ama/pub/physician-resources/medicalethics/code-medical-ethics/opinion8082.page?
Katherine L. Zaleski, MD, and David B. Waisel, MDAMA Journal of Ethics. Withholding
Information from an Anxiety-Prone Patient? March 2015, Volume 17, Number 3: 209214. Retrieved from http://journalofethics.ama-assn.org/2015/03/ecas2-1503.html
Society of American Gastrointestinal and Endoscopic Surgeons. Laparoscopic Inguinal Hernia
Repair Surgery Patient Information from SAGES. Retrieved from
http://www.sages.org/publications/patient-information/patient-information-forlaparoscopic-inguinal-hernia-repair-from-sages/