General

Please don't tell my husband

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28 Sep 2016 - General
 

Hypothetical case:

Your first encounter with Mrs. JCW was a year ago when you delivered her first baby. It was a Caesarean delivery of a healthy infant. Now, Mrs. JCW is nearing term on her second pregnancy and she followed up at your clinic for a routine pre-natal check-up. You told her everything was fine and gave her further instructions for her scheduled delivery. Mrs JCW then requests you to perform tubal ligation. You asked her if she already discussed this with her husband and she claims that her husband will never agree. She then requests you to keep this as a secret. 

How will you respond to Mrs JCW's request? Have you encountered a similar case wherein a patient is asking you to keep a secret?

Mark Edmon Tan I actually brought up this topic because I wanted to know how other doctors with different medical systems, laws and religious beliefs will handle this situation. In our country, as far as I know, doctors are not legally liable with breach of confidentiality because there are no laws on this. However, we are professionally liable to PRC (professional licensing body of the Phils) and the Phil Medic...
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That is an interesting story Francis NFA , so up to now the wife is still kept in the dark regarding her husband's situation? That sounds difficult for the both of them. I think that patients who cannot disclose and refuses to disclose their illness or any situation with their loved ones for that matter, has the right to do so. I think that convincing someone is not just an hour worth of effort, but a continuo...
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On the ethical standpoint, Mrs. JCW deserves confidentiality as she is the patient as everyone seems to agree on. However, this is not a conventional ethical situation. The main intention of having a tubal ligation is to avoid bearing children. Not wanting to bear children are grounds for annulment and even the Catholic church recognizes this. Performing a tubal ligation removes the procreative aspect of engaging in a conjugal act. I feel that the husband should be involved in the decision makin...
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@[Marinelle Castro] well more than a law it is an ethical issue in my region too. As you said early,this is truly a tricky situation. It is true that the wife should have the right to take a decision on her on her own. Therefore definietly we will have to accept her wish. So it is good if we give her a comprehensive idea about this decision as it affect the wellbeing of the family. What I have seen in such situations is that people see the side which they haven't seen before when doctors put...
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By the way, I think that the best way to answer the husband if he asks if everything is okay and if her wife can have more babies: “She’s in good health. However because of privacy issues on consultation, I am obliged to ask Mrs JCW’s permission before I discuss further with anybody. Since you are her husband and you are entitled to know about her condition, its best to discuss this with her. I’d be willing to make an appointment with both of you, should you have any clarifications”. In the Phil...
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Thank you for your responses. Priscilla Mae Gobuyan I’d have to say that I have similar encounters too when families request to withhold disclosure to elderly patients. The best thing to do there is to inform the family that the patient has the right to know about his illness based on the principle of autonomy. Francis NFA ...
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Well Mrs. JCW is our patient and we would have to keep her medical information confidential. Though as Oshen Chandrasoma mentioned, her husband has the right know about this issue as it will affect their family. The vows they made as husband and wife shouldn't concern us but ethically we should at least put some effort into trying to talk to the patient about informing her husband. I have encountered cases wh...
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Well this type of scenarios are very tricky. Here we have to keep confidentiality and at the same time her husband has to know about this issue as it affects the family. In my point of view, the first thing a doctor should try is to give a comprehensive idea to the patient regarding the effects of the tubal ligation and how such decision affect her family, specially to her husband. Husband's involvement will make things go easier. Sometimes she might see the brighter side of involving her hu...
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I think the most that we could do is talk to the patient and advise her about the possible repercussions of her decision. But she is the patient and the principle of autonomy can be applied here. Her decision as long as it is an informed one should be followed and respected. If it will be against our beliefs, we always can refer the patient to another physician. Priscilla, what you have mentioned is actually quite common. I for one believe that withholding the diagnosis to the patient should nev...
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In my case as a nurse, we have encountered some responsible folks telling us to keep the diagnosis of their patient as a secret. The most common example would be patients with cancer. I get to pity patients which aren't even knowledgeable of their situation. But based on experience, we really never tell the patients regarding this. I think it would be the responsibility of the doctors and family members to divulge the information. However we have this one scenario whereas my other colleague ...
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