CLINICAL CASE FOR DISCUSSION
Todd Z.
Lawrence P. Ulrich, Ph.D.
Lawrence.Ulrich@notes.udayton.edu


Some Issues Raised:

Todd Z. is a 75-year-old male who has been diagnosed as having lung cancer with brain metastases. His physician of thirty years, Dr. S., is seriously concerned that, if told of his diagnosis, Todd Z. will go into a deep depression and spend the remainder of his life in that state. Dr. S. keeps the information from Todd Z. and orders Todd Z.'s wife and three sons not to tell the patient of the diagnosis. He claims that "deep down" Todd Z. would not want to know about his diagnosis. He tells them that he wants to keep the patient in the hospital for a couple of weeks for brain radiation and promises to make up some excuse for the treatment. After the treatment is concluded, the family can take him home to die. Dr. S. promises that he will visit Todd Z. at his home every week and care for him until he dies because he has been very fond of him and lives nearby. Todd Z. becomes increasingly persistent with his questions about his physical condition. By the third week the family breaks down and tells him about the diagnosis. Todd Z. does go into the predictable depression, but it is not as severe as Dr. S. had feared. Dr. S. is angered by the fact that the family has disobeyed his orders. He releases Todd Z. from the hospital and does not keep his promise to visit him at home. He never visits him during the six-month period from Todd Z.'s departure from the hospital to the day of his death. During that six-month period Dr. S. is very uncooperative. When the family contacts him to discuss the medication program, he is very curt with them, and when they ask him about a particular condition that is developing, he insists that they will have to bring Todd Z. to the office or to the hospital. He even refuses to talk with the patient on the telephone.

Some Discussion Questions:

1. How does Dr. S. place Todd Z.'s autonomy in jeopardy?
2. Does depression inevitably eliminate the power of self-determination by the patient and justify a parentalistic intervention by the physician?
3. How would you characterize the quality of the fiduciary relationship in this case?
4. What components of informed consent are being ignored in this case?
5. Does Dr. S. act as a proper patient advocate in this case?
6. What has happened to trust and mutual empowerment in this physician-patient relationship?
7. Is Dr. S. exemplifying or violating any essential virtues which physicians ought to practice in the fiduciary relationship?
9. What strategies would you implement to bring this case to a resolution, which maximizes the well-being of the patient?