She appears to have very thoughtfully explored her own mind and emotions; she has involved her minister and sons in her conversations, and they are supportive of her decision. She has been judged by a psychiatrist as being of sound mind, not depressed, but making a rationally based decision.

Yes, she could just stop eating/drinking and eventually experience the same result. It would be hard. What’s the point? The same thought process has been involved.

Thanks for opening this discussion.

I believe that physician assisted suicide can be ethical and should be legal (with appropriate constraints and limits). This strikes me as an assisted suicide. At this point, the patient’s suffering is primarily existential. The case does say she experiences “significant pain in various sites” but also says that she would still wish for TS even if the pain could be controlled. Further, she does not appear willing to address this existential suffering in any way other than TS.

Janet states that TS does not seem like suicide to her because it is a medical intervention. I won’t dispute her perception–she is entitled to see it however she sees it. But it sure seems like suicide to me. She is intentionally hastening her death by choosing to stop eating and drinking (something she can still do) and she is asking for medical intervention to help her with this.

Of course, one can say that she is asking for medical intervention to help her deal with her emotional/existential suffering and that a foreseen but unintended consequence of this is that she will not be able to eat or drink and her death will come sooner. But she is refusing other methods of addressing the emotional/existential suffering. It seems that given her situation she wants death to come quicker.

I can understand that. I might not choose it for myself, but I can understand it. And I think she should be able to choose it. But it’s an assisted suicide.

Greg

In general, confidentiality in the physician/patient relationship is usually thought of as stringent concerning information of a personal nature, not necessarily every aspect of information that is communicated during a visit. Admittedly, what counts as personal information may be a bit difficult to discern at times, and the physician or other health care professional should err on the side of caution. This obligation of confidentiality to patients should extend to the physician’s discussions with his or her own family.

Without trying to exonerate this person entirely, one possibility in the situation you describe is that the physician simply didn’t consider the fact that your wife was one of his patients and that your daughter was considering Tufts University to be “personal” information in need of protection. He might have gotten this impression from the way your wife talked about it with him. Some might consider the information that your wife visited the physician to be confidential, and there are reasons to support this view. On the other hand, many people would not consider this information private as long as nothing more about the nature of the visit was revealed. And the information about your daughter’s interest in Tufts is easy to see as less than confidential.

More problematic, as you describe the situation, it’s hard to tell if the physician’s daughter knew why your wife was seeing her father, though it appears as if you are saying the daughter did know this. That would certainly suggest an inappropriate violation of the physician/patient relationship and the obligation of confidentiality, and it shouldn’t have occurred. In general, why patients are visiting health care professionals is something that the professional should keep private. If the physician’s daughter did in fact know this and spoke about it publicly with your daughter, that is a perfect example of the risks of casual disclosure between a physician and his or her family members.

Still, I’m not sure you should jump to the conclusion that your wife should find another physician. She certainly can if she thinks that would be best, but another option to consider is that this gives her the opportunity to discuss her expectations of privacy with this physician. Despite the seriousness of the obligation of privacy, it is not uncommon for health care professionals to discuss their daily lives with their spouses (less so with their children). This physician may simply have made a mistake that is not uncommon, but which your wife could ask about and then explain how uncomfortable it made your daughter and herself. She could then discuss why she liked this provider (assuming she does) and how she would like to continue with him if he is comfortable respecting the confidentiality of her discussions with him. That might be more than she wants to do, but I would be surprised if the physician did not respond reasonably to her. And good relationships are built through just this sort of dialogue. If she is unsatisfied with how he responds, she can always choose to move on at that point.

Best of luck.
Greg

My wife recently changed gynocologists. In the first visit, casual conversation with the doctor / patient (I wasn’t there – my wife’s telling me this), they make the realization that this doctor has a daughter the same age as our daughter (17, senior in high school) and what my daughter’s college goals are – ironically something in the medical field). They live in a different town, but are the same religion as us. My wife had envisioned having our daughter go to this doctor also, if this first visit went well.

At home, my wife asks our daughter if she knows the dr’s daughter through a regional religious group and she says yes. She’s put off by seeing this girl’s father for such personal medical attention, my my wife assures her about confidentiality.

At a weekend long event this past weekend, the doctor’s daughter comes up to my daughter with others around and says ‘I hear you’re looking to go to Tufts’. How do you know? my daughter asks and the girl says something along the lines of ‘oh, your mom was seeing my dad for , you know, and mentioned it.

My wife and I were floored – what else would this doctor be repeating to family, if not others? Where’s the line of confidentiality for a doctor talking to family? And to a daughter who may not understand / adhere to confidentiality? ANd who didn’t even have the sense to talk to my daughter in private?

Now my wife has to go look for another doctor. He was very friendly and caring in the visit, but if he’s going to repeat things, my wife doesn’t want her or my daughter seeing him. Hey, that friend of yours going to Tufts? I saw her today and she’s been seeing this boy for months and wondering……’?!

Thanks!

Just want to make it clear to anyone reading the case that health care ethics committees almost universally view their function as clarifying ethical dimensions of issues and seeking consensus around ethically defensible ways to move forward. They do not usually have decision making authority (though they work with the decision makers) or determine sanctions or punishment.

Good case report — its a pretty universal occurrence.

Here’s the actual location of the link: http://the-american-catholic.com/2010/05/15/nun-automatically-excommunicated-for-approving-abortion/

It should be easier to find.

If you need more information concerning Catholic teaching and bioethics I suggest visiting the National Catholic Bioethics Center. They will answer your questions concerning more complicated issues.

http://www.ncbcenter.org/NetCommunity/Page.aspx?pid=183

Enjoy and God bless!