A few weeks ago I blogged about undisclosed risks of medical treatments. Undisclosed risks are common. They might be the norm. The situation would be even worse — in some sense, much worse — if doctors knew of these risks and failed to tell their patients. It was unclear if doctors knew of the undisclosed risks I wrote about.
Recently Tyler Cowen quoted a newspaper story about Israeli doctors giving birth control injections to Ethiopian women immigrants “without their knowledge or consent.” Every commenter thought this was repugnant.
The latest RadioLab podcast (“The Bitter End”) is about the dramatic difference between how doctors want to be treated when they are near death (they want no CPR, no ventilator, no dialysis, no surgery, no chemotherapy, no feeding tube, no antibiotics, nothing except pain medicine) and how the general public wants to be treated (most people want CPR, ventilator, dialysis, surgery, chemotherapy, feeding tube, antibiotics, and so on).
The RadioLab guys were puzzled by the difference. Upon investigation, they learned that the big differences exist because all those medical procedures (except pain medicine) have much worse outcomes than the public is told. The doctors know about the bad outcomes. It is better to die, the doctors decide. Unless doctors have less tolerance for being in a vegetative state, having ribs broken, and so on than the rest of us, it is clear that most people agree to these procedures because of ignorance. They fail to know what actually happens because the people who know — doctors — fail to tell them.
In other words, a huge number of sick people are being treated without having given informed consent. Doctors are doing many things to the sick people that benefit the doctors without telling the sick people how bad those things are. If end-of-life doctors told the truth, they would have a lot less work.
The RadioLab podcast hints at the moral retardedness implied by this practice in an interview with a medical student, whom I assume was randomly chosen. Why aren’t people told the truth? the interviewer asks. “I don’t know how to communicate that effectively,” says the student. Then he communicates the truth quite effectively. Why don’t you say that? says the interviewer. People don’t want to hear that, says the student (changing his answer). They don’t want to, but they need to, says the interviewer. The student says it would be “presumptuous” to tell them the truth. Presumptuous. What universe is he in? The absurdities and pathetic justifications given by the medical student to rationalize his behavior suggest that the whole medical profession doesn’t understand there is a big problem.
The comments on the RadioLab podcast at the website also suggest that doctors fail to grasp there is a big problem. Many commenters are doctors. Some agree with the facts in the program. None expresses even discomfort with the situation. One commenter is Joseph Gallo, the Johns Hopkins medical school professor who runs the study that revealed the enormous difference between what doctors want and what the general public wants. “I second the sentiments about nurses being great,” wrote Gallo. “I would add that studies that have asked nurses about their end-of-life preferences have found similar desire to limit care.” The two sentences contradict each other. There is nothing “great” about anyone who sees this happening and does nothing.