The Ethics of Disclosure and Counseling of Patients With Thyroid Cancer

Abstract

The ethical basis for the interactions between physicians and patients is primarily grounded in the principles of beneficence and respect for persons. Beneficence emphasizes the importance of acting in such a way that patients will benefit from the interaction. The principle of beneficence is central to patients’ expectations of their physicians. Patients expect that their physicians will make recommendations that are in the patient's best interests rather than primarily in the physicians’ best interests. In previous generations, physicians were given wide latitude to make choices on behalf of their patients because, based on their education and experience, they were optimally suited to decide what was the medically optimal treatment. Patients held their physicians in high regard for those reasons as well as their status in society. This paternalistic approach to medical decision-making has, in recent decades with a growth of potential conflicts of interest, been tempered by a realization that the best interest of a patient may not always be solely grounded in the medical facts. 1 The principle of respect for persons accords patients the opportunity to make autonomous choices about what are in their own bests interests. In contemporary medical practice, physicians not only must respect the choices of their autonomous patients (or the choices of surrogate decision-makers for patients who lack the capacity to make autonomous choices) but also should encourage shared decision-making with their patients. In the era of shared decision-making, one of the central roles of the physician is to educate the patient about his or her medical condition and suggest the risks, benefits, and alternatives of various treatment options to the patient. The important role of education should, ideally, end in a recommendation of what the physician believes is the optimal treatment for the specific patient. In most circumstances, the physician should provide more than simply a menu of options, but make recommendations to the patient. The technologic advances seen in modern medicine has provided increased patient choice for diagnosis and treatment that makes the physician role as educator more important than ever.