CASE STUDY 2 Failure to Diagnose Medical Indications: A 30-year-old married father of four children was diagnosed with terminal lung cancer. If tried, chemotherapy and radiation could lengthen his life to 6-9 months. The tumor, an Adenocarcinoma, is too large for surgery since it has invaded thoracic structures. The PA discovered in the patient's chart that a routine x-ray done 2 years earlier reported a 8 mm spot where the current tumor is now.

A recommendation for follow-up was in the chart, but no action taken. Surgery would have stopped the tumor. Patient Preference: The patient has both the capacity and competency to decide, but there is no idea of knowing if he would want to be told. Due to patient confidentiality his wife cannot be asked about his preference to be told. Quality of Life: What will happen to his quality of life if told about this failure to diagnose? The primary nurse tells the Ethics Committee that it would destroy his morale and his will to live. The PA believes the patient should be told, but isn't sure of the consequences to the patient and his family.

In a legal case (Natas on vs. Kline, Kansas 1986) the ruling was that a physician may withhold information based on "sound medical judgment" if it will have detrimental effects on the patient. Contextual Issues: The attending physician who failed to follow up two years ago is no longer on the hospital staff. He could be located. Relevant and Very Important: The attorney on the Committee states that if the patient is informed, he can and probably would file a malpractice claim. Such a suit could injure the physician's career and the hospitals reputation.

However, it could win financial support for the patient's family. Decisive: Since the patient is capable and competent to make his own decisions he should be told (autonomy). He will be very upset, but logic will prevail. He will go through the process of anger, denial, and grief for his loss of life. He will then see the need to make financial provisions for his wife and young children. The physician, although he did not intentionally withhold this information from his patient, must be held responsible for such a terrible oversight, which will eventually cause the death of this young man..