Should I treat a patient who doesn't know she has cancer?

Interesting opinions. Wonder if anyone has their own experience. I will bite.

My grandfather was diagnosed with mesothelioma (he had worked in a salt plant laden with asbestos). He had 9 children in North America and was staying with them. They chose, as a family, not to tell him he had cancer. We as children knew he was sick, but were not told the C word. Our family friend was a resident at Cook County Hospital in Chicago. His buddy was a Rad Onc resident and was able to treat my grandfather with RT (Dada did not have insurance) after hours. He had significant response to treatment and lived a remarkable 4 years or so. He died peacefully back at home in India.

When we talk about cultural sensitivity, we tend to do it with our lens, even if...

As a radiation oncologist who is also licensed to practice law, I often mention to my colleagues that the ethics is the ceiling and the "law" is the floor--meaning that as healthcare providers we have a duty to uphold the ethics of medicine (Whether you believe in deontological or utilitarianism ethics, is up to you).

Going to the specific question: As oncologists, we often see patients surrounded by family, and occasionally--opposing opinions as to the course of management. This occurs more often in palliative and end-of-life situations.

One of the techniques that I have used (in patients who can make their own decisions on healthcare) is to make clear to the patient and the family that it is "my duty to the patient, and not the family." T...

I agree with trying to understand their cultural reasons for doing so. We have had this discussion from an ethical lens - a patient has a right to know details about their diagnosis but also has a right not to know. I let the family know that I cannot lie to a patient, and I allow an open space for questions. Some patients, when alone, may choose not to ask any questions - and despite it contradicting your beliefs, it may be the patient's choice.

An interesting dilemma that comes up often. My opinion is that it is not ethical to deny a person knowledge of their diagnosis. I also believe it violates the premise of informed consent. I personally insist on informing the patient of their diagnosis and obtaining full informed consent before agreeing to treat them. Exceptions might be made in cases where the patient is not mentally competent to give informed consent and has a guardian or medical power of attorney. There are also specific policies around at what age a pediatric patient gives assent versus consent.

I have had a similar experience before. Often, the family members underestimate their parents or grandparents. First, I think it is in the best interest of the patient to know what is going on with their body and their future. With metastatic cancer, one needs to get his/her affairs in order. On a theoretical basis, it is not ethical to do any procedure (or radiation) on any patient without telling them the diagnosis, treatment modality, side effects, risk and benefit ratio, etc. Against the family members's request, I told a patient about his diagnosis. Do you know what the patient told me? He said, "I knew". Then he went on to tell me... They think that I do not know... I knew it from the start... I just played along with it... First, you...

There is diagnosis... And then consequences. I am sensitive to the latter and always ask (and allow the patient to decide not the family, who can speak to you separately in the hallway if need be) "Are you ready to talk about the impact this diagnosis has on your life" etc.

If they say no, and they say no about 25% of the time... I fully respect that. They sometimes ask me later for more detailed information.

Gentle kindness is the most important thing we can offer beyond competent care.

As physicians, we have a duty to respect our patients' autonomy and provide them with all the information they need to make informed decisions about their health. While the family's desire to protect the patient from distress is understandable, withholding her cancer diagnosis compromises her ability to consent to treatment and make personal choices. I recommend discussing her condition with her, ensuring she has the support she needs to process the information. It might also be helpful to involve a multidisciplinary team, including counselors or social workers, to support both her and her family during this challenging time.

I would tell the patient that we knew what was causing their symptoms, and ask them if they wanted to know what their diagnosis was, and might even say that their family thought they wouldn't want to know. Assuming they are a competent adult, if the patient did NOT want to know their diagnosis, I'd be fine treating them, but if they DID want to know, I'd tell them regardless of the family's wishes. The patient is my patient, not their family.

I understand that there are, and am respectful of, different cultural values, etc., but I do not believe that allows me as a physician to waive my duty to inform my patient. How do you obtain "informed consent" when the patient has no idea what's going on?

Also, if you're willing to let the family dec...