"In 1970Dr. R. Browne was a kindly 63 yr old British general practitioner. He was the physician of a 16 yr. old woman since her birth. The young woman thought she should get contraceptive counseling. She realized that Dr. Browne might not look favorably upon this request, so she went elsewhere for advice- to the local birth control counseling clinic. She received the counseling, a physical examination, and a prescription for oral contraceptives. IT is standard medical practice to inform the primary physician if one writes a prescription for someone who normally sees another physician. The clinic's physician asked if he could notify Dr. Browne. Perhaps, without thinking, she gave her approval.
Dr. Browne received in the mail, unsolicited, a letter informing him that his patient was on the pill. Dr. Browne expressed 2 concerns. First he was concerned about her pharmacological well-being. In 1970 the pill had not been on the market very long. Nobody understood what the effects might be, especially in a 16 yr. old. But he was also worried about her total well-being; in particular, what he called her 'moral' health.
Dr. Browne consulted with colleagues, and came up with a plan. One day when the young woman's father was in the doctor's office, Dr. Browne told him the story.
The young woman was not pleased with this turn of events. The clinic physician was also not pleased. Dr. Browne was charged before the General Medical Council in Great Britain with the violation of patient confidentiality, 1971. Dr. Browne, in his defense introduced two documents: The Hippocratic Oath, and the British Medical Association code. The Oath says that the physician should not disclose "that which should not be spread abroad". That, in turn, has traditionally been interpreted as confirming the core Hippocratic principle, that his moral duty is to what he thinks will benefit the patient. Likewise, the BMA code explicitly permits disclosures when doing so is believed to be for the benefit of the patient. Dr. Browne, having struggled with his conscience and consulted with colleagues, claimed he did what he thought was best for his patient. He may have had a somewhat archaic view about what would benefit her, but he really believed that this was the most beneficial course."
Did Dr. Browne do the right thing?
What are some problems with what he did?
What are some good things about what he did?
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While Dr. Browne was thought to act with beneficience, his actions are more commendable in the realm of character virtue than in the realm of ethics. While due respect is given to his actions for acting in what he thought was the best interest of his patient, it is equally important to understand that he violated the patient’s confidentiality and right to autonomy.
ReplyDeleteIn a very clear way, Dr. Browne disobeyed the princple of confidentiality between a doctor and a patient in both a legal and ethical sense. Simply put, he shared information with the girl’s father without her consent or even knowledge. In a less clear way, the doctor violated the young lady’s right to autonomy. The principle to respect autonomy demands that a person acknowledge another’s right to hold personal views and take actions based on her own personal values and beleifs. This principle not only involves a respectful attitude but also respectful actions in that one is obliged to build and not hamper another’s autonomy. By acting in a way that attempted to change the young lady’s “moral health,” he directly disrespected her ability to act on her own values.
An ethical debate is defined by conflicting moral imperatives by which obeying one directly involves defying another. In the case of Dr. Browne, however, there were reasonable actions that he could have taken to both promote the welfare of his patient while not invading on her confidentiality or autonomy; therefore, his situation cannot be considered an ethical dilemma. It is a moral norm that there is no violation of confidentiality and privacy if a patient authorizes release of information to others. Therefore, Dr. Browne had the valid option of discussing his concerns with the young lady about her choices and actions. By taking this action, he could have done his best to promote beneficience while still showing respect for her autonomy and without violating her confidentiality. If after this conversation his concerns persisted, he would have had the opportunity to ask permission to share this information. Because the doctor did have a very feasible option that would not break either of the priciples but chose a route that did, he can be considered to have acted unethically.
As a sidenote, I must also acknowledge that there are varying definitions of beneficience. This is to say that some theorists define it as the intent to produce positive outcomes while others define it as actually producing positive outcomes. If you fall on the latter side of this debate, then the fact that Dr. Browne acted with the intent of beneificence is not pertinent as we do not know whether his actions produced a good outcome. In fact, we know that it produced at lease one negative outcome in that it disrespected the young lady’s right to confidentiality and autonomy as well as caused her some distress.
Dr. Browne clearly violates confidentiality with his patient when he tells the girl’s father she is taking birth control. This clear violation reveals the Dr. did not do the right thing. Although it may be argued he was acting on what he believed to be in her best interest, in this case, his moral judgment potentially could have put the girl in greater harm. For example, her father could have forced her to quit taking the pill, and she may have continued to have unprotected sex.
ReplyDeleteDr. Browne acts on his moral opinions. The girl does not want Dr. Browne or her father to know she is taking contraceptives, but Dr. Browne takes it upon himself to violate her autonomy and confidentiality based on his moral beliefs, not the patients. Dr. Browne potentially caused more harm than good. As mentioned above, even if the young woman quit taking the pills, she may have continued to have unprotected sex. In this case, the doctor fails to think of all possible consequences.
It seems Dr. Browne is acting beneficently and is acting based on the moral theory, what he believes is in the best interest of his patient, which may be viewed as a good thing in other cases, but consequentially, he violates confidentiality and autonomy. Also, as mentioned before, Dr. Browne may not have considered all the potential consequences of his actions.
Through his actions, Dr. Browne violated the patient's right ot autonomy and confidentiality. One of the key foundations of medicine is that the patient must be able to trust the doctor, so that the best possible actions can be taken in differing cases. However, this trust is not simply one sided. I believe that both Dr. Browne and the patient violated this trust.
ReplyDeleteTully Cheng
Typically, people believe that the treatment of patients is one sided: it is the doctor's duty to ; however, this is not so. The patient also has a duty to inform the doctor about any problems they may be experiencing. Clearly, by going to another physician to avoid what Dr. Browne might say, the girl violates the mutual trust between the doctor and the patient. I believe a lack of communication is the underlying to the problem, and that both the actions of the girl and the doctor are at fault.
While I believe that Dr. Browne's actions were wrong in that they violated confidentiality and the girl's right to autonomy, I think it is important to point out that he has a stronger relationship with the girl than the other physicians do, and that the girl in the scenario is only 16.
In the scenario, the girl goes to the local birth control counseling clinic in order to obatin contraceptives. From a medical standpoint, Dr. Browne's judgment (although he should have less say in the matter than the 16 year old girl) should have greater weight than the counseling clinic's. In the end he was simply acting
Furthermore, even though the legal age of adulthood is 16 in the UK, it only serves as a landmark age. Nobody magically evolves into an adult immediately when they reach 16, and it's important to recognize the importance of parental prerogative and the idea that parents only want what's best for their children. Furthermore, the girl's parents might make a more educated decision based on experience. If these conditions are given, Dr. Browne's actions may create greater good overall. He would have acted benevolently.
Of course, in actuality, these reasons do not justify Dr. Browne's infringement on the girl's rights, but it's important to see that Dr. Browne's actions were not completely wrong.
Perhaps a better method would have been to discuss the matter with the girl before notifying her father. The entire problem may have been avoided altogether.
Tully Cheng
Dr. Brown did not do the right thing when he revealed to his patient's father what should have been confidential information. He exhibited subjective hippocratic ethics by allowing his personal judgement and morals come into play. By doing this, Dr. Brown violated patient confidentiality, which could, in turn, cause harm to his patient. For example, next time, instead of going somewhere to obtain protection, the patient might be scared to and may have unprotected sex due to the fear that her parents may find out again that she was getting contraception. Dr. Brown, although his intentions may have been to help his patient morally, did not exhibit respect for his patient's autonomy. In this case, Dr. Brown should have separated his personal moral theories from his job.
ReplyDeleteBy disclosing the 16 year old's use of contraceptives to her father, Dr. Brown broke his duty to doctor-patient confidentiality. Although Dr. Brown was concerned about his patient's moral health, a doctor's defined duty does not generally include considerations for moral health. Given that moral health was outside of Dr. Brown's direct jurisdiction as the patient's physician, his overarching duty should have been that to his patient's autonomy.
ReplyDeleteIt was clear that the patient did not want her family to discover her use of contraceptives. Although Dr. Brown may disagree with her choice, he does not have the right as a medical professional to take actions that defy these wishes. At the very least, Dr. Brown's duty to doctor-patient confidentiality should have convinced him to discuss the matter of contraceptives with the patient directly first before taking the issue to her parents.
In addition to violating the principle of autonomy, Dr. Brown may have also inadvertently violated the principles of beneficience and non-malfeasance. Because the doctor's actions, the patient may be forced to give up on contraceptives. This would force her into a potentially dangerous situation because if she chose to, in an act of defiance, then engage in unprotected sex, she might get pregnant.
In addition, Dr. Brown may be forcing his other patients to forgo contraceptives or look for illegal off the book sources for contraceptives after hearing that Dr. Brown reveals the use of contraceptive use to patients' parents. By forgoing contraceptives, his other patients may also get pregnant or even accidentally obtain unsafe drugs in their search for an illegal off the records source for contraceptives.
Thus, Dr. Brown acted unethically in an even greater utilitarian sense that goes beyond the immediate patient and doctor involved in this specefic case.
Dr. Brown was attempting to protect his patient's moral health in an act of benefecience, but during the process he violated many overarching ethical principles.
~Ankit Agarwal
Dr. Browne did not act ethically in telling the patients father about the letter, or that the woman had sough outside treatment. Dr. Browne violated patient privacy and confidentiality. While he might have thought that he was acting in the patients interest he actually probably did more harm than good. First of all he lost the trust and confidence that the woman had in him which will harm further interactions and probably cause her not to inform him of other health problems that she has in the future. This will interfere with her health care and she might not receive proper treatments. While he might have thought that he was acting accordin the the Hippocratic principle he probably harmed the patients health more than he helped her. She was seeking help from an outside clinician on an important issue regarding her health—something she has every right to do. Now she might also be reluctant to seek help with these issues. He also might have harmed the woman’s relationship with her father and family depending upon what his beliefs are. What a doctor knows about a patient should never be spread without the patients consent because it could have consequences that the doctor might not know about depending upon the different persons situation. He did act in a way that he though was beneficent, however failed to consider factors other than just the womans specific health issue. He could have address the concerns with the woman herself before he went and spoke to her father.
ReplyDeleteThe problem lies in the determinacy of when a child becomes an adult and is capable to make their own decisions. It is not until this point, that a child can withhold medical information from their parents. Many government systems have set an age for when a child can legally become an adult. In the United States, the consenting age is eighteen so Dr. Brown’s actions would not be considered wrong or unethical. I am not sure what the age of consent was in Great Britain during the 1970’s so I can not say for sure whether Dr. Brown’s actions were right or wrong. If sixteen was the legal consenting age of an adult I believe Dr. Brown broke the law and breached patient confidentiality, even though he had the best interest in mind for his patient. Conversely, if the sixteen year old girl was indeed a minor, I believe the clinic should be held responsible for not informing the parents of the care their daughter received and especially for prescribing medication that had limited studies on the long term effects without the parent’s consent. In addition, if the girl was still a minor, the parent’s are still allowed and have the right to have access to their child’s entire medical record, which acquits Dr. Brown of any legal and ethical wrong doing. Although Dr. Brown was attempting to help his patient and provide the father with the best medical advice, if the child was of legal consenting age, then he was wrong and should be held responsible for his actions, even though it seems like the ethical thing to do.
ReplyDelete