Q: I am a single, 62-year-old woman with a full-time job. Two years ago I allowed my 87-year-old mother, then quite ill, to live in my home with a 24/7 caretaker. Mother is now in good health, with mild dementia, but still needs the caretaker. I would desperately like them out of my home. None of my six siblings can take her in. What is my obligation?
– Name Withheld, California
A: You (as well as your siblings) have an ethical obligation to see that your mother is well cared for, a task you’ve shouldered admirably, not a duty to make her your permanent roommate. But I suspect that you were not contemplating leaving her at the curb on recycling day, just lamenting the current arrangement.
It’s easy to recognize this obligation – when we’re children, our parents care for us; when they’re elderly and need help, we look out for them – but harder to describe how to meet it. Finding a way to do so is something for you, your mother (if she is sufficiently lucid) and your siblings to discuss. In devising a solution, your happiness too is worthy of consideration. You may not abandon your mother, but she may not ignore your wish to lead your own life.
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Q: I am a retired orthopedic surgeon who volunteers at a clinic for the indigent elderly. I treated a woman who has obviously been crippled by a surgeon. She will soon lose the ability to walk and has chronic pain. She is unaware of her right to sue for malpractice. Am I obligated to inform her, particularly when I know that she will need the money for continuing care?
– Name Withheld, Florida
A: You must give your patient a true understanding of her condition, and that conversation may reasonably address the treatment that brought it about. If you were discussing the case with a colleague, surely you’d opine that the patient was ill-served by her doctor. Your patient is entitled to the same candor.
Her legal options, too, are germane. Physicians often consider a patient’s economic circumstances. (Is a patient insured? Can she afford her medication?) As you note, the economic relief she might gain through the courts can have a significant effect on her medical care and thus is within your purview. You may not offer legal advice, but you should encourage her to seek it.
I understand your reluctance to disparage a colleague or embroil another doctor in a malpractice suit. But your primary obligation is to your patient’s health, not to your colleague’s reputation. If you do not give her this meaningful information, how is she to get it?
UPDATE: The physician not only discussed his patient’s previous treatment but also referred her to an attorney specializing in medical malpractice. He told this attorney that he could not testify in any proceeding, lest his receiving payment as an expert witness suggest a conflict of interest.
Send questions and comments for Randy Cohen to Universal Press Syndicate, 4520 Main St., Kansas City, MO 64111, or ethicist@nytimes.com.
