John, a 20-year-old male with colon cancer, underwent surgery in which a significant portion of his large intestine. Because so much intestine was removed, a colostomy had to be installed for her excretory system to function. The operation was successful, but John still needs to undergo chemotherapy to ensure no cancer cells remain. Say no to plagiarism. Get a tailor-made essay on "Why Violent Video Games Shouldn't Be Banned"? Get an original essay. The problem is that John is very depressed after the surgery, especially at the prospect of wearing a colostomy bag for the rest of his life. He's not interested in talking to anyone about anything, including the chemotherapy his surgeon wants him to undergo. He is also unwilling to care for his colostomy, and the nurse is concerned about the possibility of an infection at the colostomy site. The surgeon tried to help John. His family and friends tried to encourage John and even had a former patient talk to John about how the colostomy had not drastically changed his lifestyle. The surgeon fears that if this state of mind persists, John will have difficulty, if not impossible, with chemotherapy. All this changes when one day, a family member tells John that colostomies can sometimes be reversed. John, ecstatic, asks his doctor why he didn't talk about it before. The surgeon is surprised, accepts and starts to answer, but is interrupted by John and says nothing else. John undergoes chemotherapy and a year later the cancer is gone forever. John asks the doctor to remove the colostomy. The doctor tells him that his colostomy actually cannot be removed. John replies that it's okay because he's learned to live with the colostomy and is just happy that the cancer is gone. Uncertainties There are uncertainties relating to chemotherapy. First of all, we do not know whether John would agree to undergo chemotherapy in his depressed state. It is possible that, given his listlessness, he will decide to refuse conventional treatments, even if they are medically necessary and could lead to the cancer returning. If John underwent chemotherapy in a depressed state, how would he react, both physically and mentally? Would his immune system collapse (leading to physical damage), or would he have a nervous breakdown (leading to mental damage)? The severity of the side effects would determine whether nondisclosure is warranted. We also don't have much information about John's reactions. If the doctor revealed that the colostomy is not reversible, would John continue to be uncooperative regarding the care of his colostomy? It is possible that if this state of mind persists, an infection may occur, leading to another set of harmful side effects. We also don't know if John is actually as happy about keeping the colostomy as he appears to be. We know he was depressed and we don't know what effects the chemo had on him. If he is still depressed, then this realization must be a blow to him, and he may simply say that he is fine with the colostomy, but not really. We don't know much about John's mental condition. Is your depression affecting your ability to make decisions, and if so, are you able to make rational decisions? We don't know if he is receiving any kind of mental health care, such as counseling from psychiatrists or antidepressant medication. We also do not know whether John's depression regarding his colostomy is normal compared to other colostomy patients. This could haveinfluenced the surgeon's decision not to tell John that his colostomy is irreversible, especially considering that the surgeon is a trained professional who has likely faced similar situations in the past and may have prior knowledge on how to handle the situation. I don't know much about the doctor's motivations and actions. For example, is the doctor really acting in the patient's best interests by recommending chemotherapy, or is it possible that he or she is more interested in things like financial reward? Furthermore, the surgeon appears to be the only medical professional who decides whether or not to make the disclosure, so would his response have changed if there had been other medical personnel in the room with him? Finally, what would the doctor actually say before John interrupted him? Did you intend to tell John that his colostomy was not reversible, but seeing his reaction, decided against it? There are three principles at play here: autonomy, beneficence, and nonmaleficence. Autonomy means that the patient is able to make his or her own informed choice regarding the medical procedures to which his or her body is subjected. In this case, John must know all the facts regarding his situation and must be able to decide whether to undergo chemotherapy intentionally, freely and voluntarily. The doctor's failure to disclose the non-reversibility of his colostomy has a direct impact on John's independence. By hiding a fact, the doctor does not allow John to make a fully informed decision. John's autonomy is also limited by his own depression. His concern about the colostomy affects his competence and how rational he can be, although the severity of his depressive symptoms is unclear. It can therefore be argued that John's depression “gives up” his right to make his own decisions and therefore justifies the doctor's non-disclosure. The principle of beneficence holds that the doctor's sole goal is to heal the patient. The doctor must look after the patient's well-being, and in this case, that means ensuring that John is cancer-free and mentally healthy. From a charitable standpoint, the doctor did the right thing by not disclosing that John's colostomy was not reversible. This action brought John psychological relief, which allowed him to successfully undergo chemotherapy and ultimately become cancer-free. However, it's unclear whether John is happy living with his colostomy, so his mental health may suffer. Nonmaleficence means that the doctor is not intentionally creating harm. In this case, regardless of what the doctor chooses to do, the possibility of harm exists. If the doctor reveals that the colostomy is not reversible, John's depressed mood will continue and his colostomy may become infected. If you choose to undergo chemotherapy while depressed, you could potentially suffer mental and/or physical harm. He may be suffering from a nervous breakdown or his immune system may be compromised. If John chooses not to undergo chemotherapy, the cancer has the possibility of returning. However, if the doctor withheld this information, John could suffer psychological harm. You may experience mental anguish and doctor-patient trust may also be damaged. Both decisions have potential harm, but choosing nondisclosure carries less harm than choosing disclosure. Possible Case Solutions The doctor immediately corrects John and tells him that his colostomy is not reversible. The doctor lies to John and tells him that his colostomy is also reversible. however it is not. Our Resolution: The doctor does not confirm John's colostomy type and allows John to.