CLINICAL CASE FOR DISCUSSION
Marcia W.
Lawrence P. Ulrich, Ph.D.
Lawrence.Ulrich@notes.udayton.edu


Some Issues Raised:

Marcia W. is a 40-year-old female with multiple myeloma, who, upon diagnosis shows great interest in having all the information that is necessary to make a decision about further treatment. Dr. C. tells her that the response rates to chemotherapy with this disease are very good and that recent research has shown that 50% of patients can hope for long-term survival rates, which are tantamount to cure. The other 50% of patients die within a year or two. What Dr. C. neglects to tell her is that preliminary studies are showing that in 20 years, 10 % of the 50% who survive contract a form of leukemia that is highly resistant to treatment. When her treatment is discussed in a staff meeting, Dr. C. says that he did not want to tell Marcia W. about the 10% because he was afraid that it might unduly alarm her and cause her not to take treatment, thereby spoiling her changes for long-term survival. Moreover, he states (a) that the research is not conclusive enough to suit him and (b) that 10% is such a low figure that he is not morally required to communicate the risk. After all, he suggests, one cannot inform a patient of every risk.

Some Discussion Questions:

1. How would deontology address the issues in this case?
2. How does the deontological understanding of autonomy contribute to addressing the issues in this case?
3. Is Dr. C. acting as a professional (grounded in deontological insights) in this case?
4.  How does the Kantian notion of "respect for persons" figure in this case?
5. Is Marcia W. a "means" or an "end" in this case?
6. What strategies would you implement to bring this case to a resolution which maximizes the well-being of the patient?