NEW YORK — Daniel Sulmasy, OFM, MD, PhD, chairman of the ethics department at St. Vincent’s Hospital here, was among 10 doctors and ethicists from leading hospitals here asked to comment on hypothetical ethical dilemmas in the June 8 issue of New York magazine. It was the magazine’s annual “Best Doctors” issue.
In an article called, “Can One Sibling Pull the Plug If the Others Don’t Want To? And Five Other Vexing Medical-Ethics Dilemmas, Examined,” Daniel gives his opinion on the right thing to do in several examples of medical decisions that families may face.
The reporter, Janelle Nanos, talked to a panel of doctors from the New York University School of Medicine, Montefiore Medical Center, Memorial Sloan-Kettering Cancer Center, and others, including Dan, who is the Sisters of Charity Chair in Ethics, John J. Conley Department of Ethics at St. Vincent’s Hospital,and a professor of medicine and director of the Bioethics Institute at New York Medical College in Valhalla, N.Y.
Case No. 1
The magazine asked Dan to comment on Case No. 1: A doctor who had a disease that interferes with his ability to treat patients.
The magazine reporter said that an anesthesiologist went to see a fellow doctor, who was having brief lapses of consciousness related to complex partial seizures. He admitted to having at least one seizure while operating that was so brief that no one observed it. The condition was treatable but left the second doctor uncertain about whether to uphold the privacy of the doctor-patient relationship or to inform the hospital staff.
The panelists said that a hospital’s first priority is to ensure that doctors do not operate while intoxicated, and the same standards apply to illness: The protection of patients in the OR trumps doctor-patient privilege. Unless proper treatment is certain to allow the anesthesiologist to practice safely, his condition should be disclosed to the hospital, according to Dan. “The threat of serious harm to the patients goes beyond the limits of confidentiality,” he added.
Case No. 4
Dan also commented on Case No. 4: A man dying of AIDS who didn’t want his family to know.
The magazine article read: A man lived with HIV and AIDS for 14 years without telling his family. He was admitted to the hospital with pneumonia, and told his doctors not to tell his family or friends. His condition rapidly deteriorated, and he fell into a coma. Several family members arrived at the hospital, including the patient’s brother, his health-care proxy agent. Were the doctors obligated to honor the patient’s wishes, or should they have informed his brother of his condition?
Dan said: “The duty to maintain confidentiality is a strong but not absolute principle.” In this case, that duty has to be weighed against the possibility that telling the brother might influence the treatment choices he makes on the patient’s behalf.
Dan is often asked to be a media resource, and over the years has been seen on many TV news shows as well as in print.