WHAT ARE CLINICIANS OBLIGATED TO TELL PATIENTS WITH POOR PROGNOSES?

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When a patient is given a diagnosis with a statistically poor prognosis (<5% survival), what can I legally and ethically say about the expected outcome? I want my patients to be able to choose treatment options that are in keeping with their desired quality of life without losing hope. I also want patients to be able to prepare for the inevitable end but do not want to leave them susceptible to “survivor’s guilt” or lead them to make unwise financial decisions.
—Lucy Armstrong, GNP, Rochester, Minn.

A clinician’s legal duty is to provide patients any requested information as well as additional facts that a “reasonable person” would want in order to make a decision. However, the time frame and method of imparting such information is not mandated. Experience shows that patients tend to ask for the details they want and need and stop asking when they hit the point of information overload. The ethical aspect is more difficult, but most ethicists suggest that providers should give patients the tools and information to make their own decisions and then step back. However, patients often look to their providers for guidance at some point in the process.
—David S. Starr, MD, JD (98-15)

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