An 80-year-old man is brought to the emergency department by his son due to acute shortness of breath. The patient reports a chronic cough and a 13.6-kg (30-lb) weight loss over the past 6 months. Chest x-ray demonstrates a large mass in the right lung and an associated pleural effusion. The patient is hospitalized and undergoes bronchoscopy with biopsy; the pathology report comes back as bronchogenic carcinoma. When the physician initiates a private discussion about the biopsy results, the patient says, "I prefer not to be told anything. You can discuss everything with my son. I trust his judgment." The patient is cognitively intact without signs of mental illness. Which of the following is the most appropriate response by the physician?

Question

An 80-year-old man is brought to the emergency department by his son due to acute shortness of breath.  The patient reports a chronic cough and a 13.6-kg (30-lb) weight loss over the past 6 months.  Chest x-ray demonstrates a large mass in the right lung and an associated pleural effusion.  The patient is hospitalized and undergoes bronchoscopy with biopsy; the pathology report comes back as bronchogenic carcinoma.  When the physician initiates a private discussion about the biopsy results, the patient says, "I prefer not to be told anything.  You can discuss everything with my son.  I trust his judgment."  The patient is cognitively intact without signs of mental illness.  Which of the following is the most appropriate response by the physician?

Quizplus · Accepted Answer

Patients have the right to preemptively refuse to receive medical information. This patient has expressed a clear preference and has the capacity to make health care decisions. It is important to respect his wishes by withholding the information. In this case, respecting patient autonomy means respecting his decision not to know and to defer decision-making to his son. Reasons for refusing to receive medical information are varied and complex and include personal values (eg, fatalism), psychological concerns (eg, fears of bad news and mortality), and cultural beliefs (eg, cultural preference for the family to make treatment decisions). In some cultures, direct disclosure of a serious illness to a family elder may be considered unnecessarily cruel or disrespectful, and it is customary for family members to make health care decisions for the patient. Other cultural reasons for nondisclosure include the belief that open discussion may cause unnecessary anxiety, depression, or hopelessness or that speaking aloud about a condition makes death or terminal illness more certain. Physicians should respond to different individual and cultural values with an open, sensitive approach that conveys respect for the preferences of the patient and family. (Choice A) This statement may be perceived as judgmental and impair rapport. A patient has no obligation to hear the results of an intervention and has the right to refuse procedures or information at any time. (Choices B and E) The patient has decision-making capacity, and his preference not to be informed should be respected. Questioning the patient's decision and consulting with the chaplain or the patient's son are not necessary and may be perceived as disrespectful. (Choice C) This response puts pressure on the patient to accept the information when he has clearly stated that he does not want to know. Educational objective: Patients have the right to refuse to receive medical information for individual or cultural reasons. In some cultures, family members may make health care decisions to avoid perceived harm, disrespect, or mental distress caused by direct disclosure to the patient.

An 80-Year-Old Man Is Brought to the Emergency Department by His