Modules

Cross-cultural communication

Part 2

  • Consent revisited, A

  • Dr. Tyson: Dr. Cunningham is going to explain the cancer treatment options and try to get Panos into a study. She is going to use the family to translate, so, I suggested that she do it through the younger daughter Maria. I think that there’s a better chance of Panos making an informed decision.

    (transition to the conversation between Dr. Cunningham and Panos)

    Dr. Cunningham: So tell him that his back pain will return unless we treat him, and there are two ways of doing that. We’re not too sure which is the best, so we are doing a trial to figure that out. There are two choices: one of them is through chem … um, medication … and there are side effects to that which we can go through, and the other is what we call an orchiectomy, and that means it’s an operation to remove his testicles. Now, that treatment is good for advanced … well, problems of this type. But, we are not sure …

    (Panos and Maria converse in Greek; Maria and Sophia leave)

    Panos: Doctor, you know what you do … give me best treatment.

    Dr. Cunningham: So, you do speak English?

    Panos: Yeah, no, but, a little bit I understand.

  • Consent revisited, B

  • Dr. Cunningham: Well, it’s just not that simple. I mean, those treatments are effective, but we just don’t know which one is best for somebody with … well, somebody like you.

    So, what we are offering you is put you into what’s called a clinical trial, and that means that we’re going to … it means that, in actual fact, that you get put into this trial, what’s called randomly, and into one of these treatments or the other treatment.

    Now, of course, because since one of the options in this case is surgical, we would know which treatment you are getting. You’ve already said yes and agreed to the prostate surgery, and we went through all of the complications that could happen with that. Now, the other arm of this trial, if you got put into that, is with chemotherapy, which means you would have to take some pills, and the side effects of the pills would …

    Panos: I’m go home, go to job, back to the restaurant to work?

    Dr. Cunningham: Well, I just don’t think you’re going to be strong enough. You see, this kind of treatment is very difficult …

    Panos: I gotta go home, I gotta go back to work, I gotta open my restaurant again. I gonna lose my customers …

    Dr. Cunningham: Well, maybe …

  • Consent revisited, C

  • Dr. Tyson: It’s never easy to break bad news but when his daughter Niki asked me not to tell her father that he had cancer …
    (transition to hospital waiting room)

    Dr. Tyson: I’m afraid it isn’t good news … (hesitates) … Listen, there’s … there’s no easy way for me to tell you this, but … Mr. Kostopoulos has prostate cancer that has metastasized to his bones. The bone in his spine has been affected, and that’s why he was getting all that back pain. I’m surprised he didn’t have urinary symptoms. That’s something that …

    Niki: Well, he’s not one to complain, he never complains, but are you sure? Couldn’t it be something else?

    Dr. Tyson: I really very much doubt it. His prostate is very enlarged. We don’t have the biopsy results back yet, but his blood test for cancer was very high. There are some things we can try to help him …

    Niki: Look, look, there’s just one thing … he can’t find out, you can’t never tell him about the cancer … absolutely not. Mom, okay, but he can’t find out.

    Dr. Tyson: Well … um … there could be a problem with that …

Reflective exercise 5

In this encounter between Panos and Dr. Cunningham, the oncologist, we revisit some of the issues around the consent process. In “Consent and confidentiality,” we saw the basics at work: voluntary, informed and (not required there), capacity. We will now see that many of the issues that arise in the daily work of physicians are not quite so clear-cut. Being informed and understanding and appreciating consequences is just the beginning of a process called “shared decision-making.” This is an area of bioethics in which consent, paternalism and autonomy interact in an ongoing process.

Before considering further the situation of Panos and the physicians, read the following articles:

After reading the literature on decision-making, complete the following exercise. Remember that there are no right or wrong answers, but you should be able to support your responses with a reasoned argument. This is a good exercise for group discussion.

  • Consent revisited, B

  • Dr. Cunningham: Well, it’s just not that simple. I mean, those treatments are effective, but we just don’t know which one is best for somebody with … well, somebody like you.

    So, what we are offering you is put you into what’s called a clinical trial, and that means that we’re going to … it means that, in actual fact, that you get put into this trial, what’s called randomly, and into one of these treatments or the other treatment.

    Now, of course, because since one of the options in this case is surgical, we would know which treatment you are getting. You’ve already said yes and agreed to the prostate surgery, and we went through all of the complications that could happen with that. Now, the other arm of this trial, if you got put into that, is with chemotherapy, which means you would have to take some pills, and the side effects of the pills would …

    Panos: I’m go home, go to job, back to the restaurant to work?

    Dr. Cunningham: Well, I just don’t think you’re going to be strong enough. You see, this kind of treatment is very difficult …

    Panos: I gotta go home, I gotta go back to work, I gotta open my restaurant again. I gonna lose my customers …

    Dr. Cunningham: Well, maybe …


 

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