“Doctor’s Dilemma”

1 A fifty-nine year-old man, separated from his children and with no other living relatives, under went a routine physical examination in preparation for a brief and much anticipated trip to New Zealand.  The results were quite conclusive: The man had an inoperable, incurable cancer of the prostate.  The carcinoma was not yet advance and was relatively slow growing.

2 The physician had treated this patient for many years and knew that he was very fragile in several respects.  The man was quite neurotic and had an established history of psychiatric disease—although he functioned well in society and was clearly capable of rational thought and decision-making.  He had recently suffered a severe depressive reaction, following the death of his wife, who died after a difficult and protracted battle with cancer.  Just as he was getting back on his feet, the opportunity to go to New Zealand materialized, and it was the first excitement he had experienced in several years.

3 This patient also had a history of suffering prolonged and serious depression whenever informed of serious health problems.  His physician therefore thought that the disclosure of the carcinoma under his present fragile state would almost certainly cause further irrational behavior and render the patient incapable of thinking clearly about his medical situation.

4 When the testing had been completed and the results were known, the patient returned to his physician.  He asked nervously, “Am I OK?”  Without waiting for a response, he asked, “I don’t have cancer, do I?”  The physician answered, . . .  

[Consider this case without the third paragraph, that is, without the knowledge that this man suffers severe depression over health problems.  Does it change your opinion?]