Bioethics is an important element in the decision-making processes of medical professionals. Mrs. Brown, who is forty-two years old and currently pregnant, requests a genetic test to confirm whether her unborn child has Klinefelter’s Syndrome, which is characterized by an extra X chromosome in the genetic sequence – XXY (Bojesen and Claus,807). The possible defects of Klinefelter’s syndrome include sterility, excessive tallness, enlarged breasts that can be corrected through surgery, behavioral issues, and possible mental retardation (Bojesen and Claus 807). Mrs. Brown’s fears for her child to undergo gender- identity crises when she grows up. She also fears her child might become retarded despite assurances that this is an outdated notion of Klinefelter’s syndrome. Such fears spark her inclination towards therapeutic abortion. The results are positive for the disease, and this brings up the question of the physician's role in withholding information from the patient to prevent them from making drastic decisions. The issue of telling the truth to patients in certain circumstances is a prevalent concern of bioethics; doctors should withdraw the truth about a patient’s medical state if it is in the interest of helping the patient.
Literature Review
According to David Thomasma’s article “Telling the truth to patients: A clinical exploration,” the issue of truth telling to patients at the risk of their health benefits and interests can be problematic. However, there is need to assess the situation before telling the truth to a patient who might not benefit from it (1).Thomasma’s conclusion is that it is acceptable for a physician to withdraw the truth from patients if it is for their benefit and only if there is a system in place through which the truth will out in due time (Thomasma 3).
Thomasma provides a number of clinical circumstances in which it would be acceptable to intervene between the patient knowing the truth, and he uses this evidence to support his conclusion effectively. In the cases of interventions where the patient might not react rationally to finding out the truth and when the patient is dependent on others for survival for instance, after an accident that left him/her paralyzed, careful management of the truth is essential in these situations and should be to the benefit of the patient (Thomasma 1). In long-term cases, the truth should be revealed gradually. In the cases of patients who are dying, the truth should be revealed progressively or interpretively. In prevention cases, such as of prostate cancer, the issue of quality-of-life is more important than the truth. In nonintervention cases, he stresses the importance of values over that of the truth (Thomasma 2). The author does not disregard the patient’s right to the truth but rather he assesses the situations that would play a role in obstructing the truth telling process.
Commentary and Recommendation
The principle of beneficence proposes that helping patients is a primary objective and; thus, medical professionals should make decisions to protect the interests of the patient in question. The doctor should withhold the information from Mrs. Brown in applying the values of the principle of beneficence because the harm of this information. Mrs. Brown’s abortion will be of higher consequence than the contrary. Both Mrs. Brown and her unborn child will benefit and suffer from the decision of withholding the truth; Mrs. Brown will experience negative psychological and social effects if she gets the abortion because she might not get another chance at getting pregnant because of her age and the pain of losing a child will linger. The unborn child will also suffer medically and socially. It is tough to live with such an illness and also discrimination is a reality in most societies against those who are different (Bojensen and Gravholt, 811).
The principle of autonomy suggests that doctors should treat patients as rational individuals and allow them an opportunity to make their decisions. It would force the doctor to reveal the truth about the illness of the unborn child to its mother and expect her to make the right decision despite her predispositions. Applying Kant’s categorical imperative “treating humanities as ends-in-themselves” and “respecting human dignity, “ translates to mean that the value of human life is built-in them, and it should not be lessened through degrading them in any way; for instance, through forcing decisions on them. The emphasis of this imperative would be on rationality than the autonomy of decisions because there are numerous instances in which human beings are incapable of making rational decisions even though they are of their accord such as the case of mental instability (Giubilini 56).
The recommendation would be to withhold the information from Mrs. Brown. In her state of being pregnant and emotional, overwhelming information might force her to make a rush decision only to regret it later. In relating Mrs. Brown’s case to Thomasma’s thesis; the case of Klinefelter’s disease is labeled a nonintervention case in Thomasma’s article as it is a "genetic disorder that may be diagnosed in utero (3)." Giubilini refuses to support the notion that abortion might be a kind choice and that abortion would be a choice that is against the interests of the unborn human being (Giubilini, 49). Therefore, the recommendation to Mrs. Brown’s case would be that of withholding the truth from her to prevent her from seeking a therapeutic abortion. Allowing Mrs. Brown the chance to abort her unborn child over what might be a mild disease would be the wrong option for the doctor as this decision is likely to be followed by regret for both the doctor and patient.
Conclusion
The case of Mrs. Brown who is a pregnant woman over forty years of age and carrying a child who has tested positive for Klinefelter’s disease reveals a bioethical issue of whether the doctor should inform her of this fact as knowing will result in therapeutic abortion of the fetus. From Thomasma’s article, there is evidence of the cases that support his conclusion on the instances that allow for doctor’s to withdraw information from their patients. He characterizes Mrs. Brown’s case as a “nonintervention case” and proposes the value of values over that of telling the truth. This essay serves to support the thesis “The issue of telling the truth to patients in certain circumstances is a prevalent concern of bioethics; doctors should withdraw the truth about a patient’s medical state if it is in the interest of helping the patient.”
Works Cited
Bojesen, Anders, and Gravholt, Claus H. “Morbidity and Mortality in Klinefelter syndrome (47 XXY)” Acta Paediatrica 100. 6 (2011): 807-813. Print
Giubilini, Alberto. "Abortion and the Argument from Potential: What we Owe to the Ones who Might Exist". Journal of Medicine and Philosophy 37.1 (2012): 49-59. Web.
Thomasma, David C. "Telling The Truth To Patients: A Clinical Ethics Exploration". Cambridge Q. Healthcare Ethics 3.03 (1994): 375. Web.
