Philosophy Now Forum

If a Medical Doctor is taking a patient's blood quite often as part of cancer treatment, and if a non-patient third party X suggests the Doctor check the blood for poison (murder) while he's at it, must that Doctor disclose to the patient the fact that the suggestion was made?

I know the Doctor would have to tell the patient, and possibly even the cops, if the test was done and poison was found, but must the Doctor tell the patient about the suggestion before testing, or if tested and no poison was found?

X might be in big trouble with the patient if it turns out there is no poison. Thus, X would prefer not to have the suggestion revealed if there is no poison. The patient would know who X is if told the suggestion was made, thus, anonymity is not an option.

Thoughts?

From what I've heard of her, it sounds like something Agatha Christie would be interested in.

The medical staff and all who comprise it are advocates for the patient.

Huck Mucus wrote: ↑Tue Jan 15, 2019 1:58 am If a Medical Doctor is taking a patient's blood quite often as part of cancer treatment, and if a non-patient third party X suggests the Doctor check the blood for poison (murder) while he's at it, must that Doctor disclose to the patient the fact that the suggestion was made?

I know the Doctor would have to tell the patient, and possibly even the cops, if the test was done and poison was found, but must the Doctor tell the patient about the suggestion before testing, or if tested and no poison was found?

X might be in big trouble with the patient if it turns out there is no poison. Thus, X would prefer not to have the suggestion revealed if there is no poison. The patient would know who X is if told the suggestion was made, thus, anonymity is not an option.

Thoughts?

Firstly, the doctor seems to have violated patient confidentiality by discussing their patient with a 3rd party.
If the tip was unsolicited - then the doctor has no obligation to disclose to the patient that he was tipped off to begin with.

The blood is ownership of the patient. All decisions as to what is to be done with the patient's blood and is up to the patient.

Therefore the doctor can simply present the patient with the option to choose whether to have their blood tested for poison on the grounds that the symptoms seem consistent with poisoning.

It's not up to the doctor to suspect malice - the poisoning could be entirely accidental. The doctor's job is healing.
The doctor would not withhold a viable blood test and a potential cure simply on the grounds of protecting a 3rd party's privacy, and there's no reason to start now.

Primum non nocere.

Huck Mucus wrote: ↑Tue Jan 15, 2019 1:58 am If a Medical Doctor is taking a patient's blood quite often as part of cancer treatment, and if a non-patient third party X suggests the Doctor check the blood for poison (murder) while he's at it, must that Doctor disclose to the patient the fact that the suggestion was made?

I know the Doctor would have to tell the patient, and possibly even the cops, if the test was done and poison was found, but must the Doctor tell the patient about the suggestion before testing, or if tested and no poison was found?

X might be in big trouble with the patient if it turns out there is no poison. Thus, X would prefer not to have the suggestion revealed if there is no poison. The patient would know who X is if told the suggestion was made, thus, anonymity is not an option.

Thoughts?

A. Maybe it's a plot to get the patient bankrupt. Testing for poisons is very expensive, usually only forensic labs are equipped to do it.

So if the doctor asks the patient, "Do you want to be tested for poison X?" and he says yes, then it may cost him an arm and a leg.

The cost to the patient may rise even higher, if the poison is unknown. Then the doc has to test for several poisons, each costing an arm and a leg. Only centipedes can afford that.

B. If there is murder involved, with poison, then the patient is dead. You can't have murder without a dead body.

C. Poisoning always is accompanied with typical symptoms. There is no known poison that makes the patient behave and feel completely normal, until one day he goes "Tralla-la, tralla-la," and he keels over and dies. No symptoms mean no poisoning.

D. If symptoms, and the poison indicated in the tip by X is compatible with the symptoms, it's a completely different ball-game. Then the doctor must pull in the cops.

1. The Doctor is not discussing anything with a third party. The Doctor is listening.
2. The Doctor is not being asked to suspect malice. X suspects malice.
3. As stated in the hypothetical, “I know the Doctor would have to tell the patient, and possibly even the cops, if the test was done and poison was found.” That is not the question.
4. It would do harm to tell the patient about X unless poison was found to be the source of the cancer.
5. There is no plot to bankrupt the patient: A. The patient is wealthy; B. The patient’s wealth, and “coincidence in timing of other events” is the basis for X’s suspicion. Think Black Widow, gold digging, very recent marriage, prior similar situations with the suspect.
6. X assumes the Doctor would know which poison to look for, based upon the type of cancer, history, etc.
7. The patient is not dead so correct, murder has not occurred, yet. I put “murder” in parentheses, instead of “attempted murder”, as a shorthand to indicate the basis for X’s suspicion, assuming (I know, my mistake) the reader would be able to figure that out. My bust.
8. The symptom of the poisoning, in this case, might be the cancer. Hence the inquiry.

X’s suspicion may be objectively, factually, or medically unreasonable. X’s interests are primarily familial love and, secondarily, monetary. X does not want to add to the patient’s concerns with unfounded drama, etc. The patient already, obviously, has a lot to worry about. On the other hand, if anything is to be done, it might best be done before it’s too late for the patient, or before evidence is lost.

Huck Mucus wrote: ↑Tue Jan 15, 2019 3:25 pm 4. It would do harm to tell the patient about X unless poison was found to be the source of the cancer.

Even if poison was found to be the source, the doctor still retains the discretion not to tell the patient how/why they got this information.

Frankly, if the doctor needed a tip-off to suspect foul play, they simply ignored a probable diagnosis given the symptoms.

But they will have to disclose this to the police.

I understand now. X notifies the doc of the possibility of poison. Does the doc inform the patient of the suggestion? Before test? After test? And if after test, if negative? If positive?

Any poison? Or a particular one?

If no particular poison, just general, then X suffers from paranoid schizophrenia.

If a particular poison, then it either causes cancer or it's a different kind of poison.

If particular poison causes cancer, doc suggests to patient to take the poison test and pay for it. Why, says the patient. As a precaution, says the doctor. We must look at every angle in the cure. (A lie.) Identity of tip-giver may or may not be given by doctor, it's up to his discretion.


If particular poison does not cause cancer, then are there symptoms of poison?

If no symptoms of poison, then tip to request test can be ignored.

If typical symptoms of poisoning, then doc must tell patient "we had better test for this" to allow him to test blood for poison. If patient objects, no test. If patient accepts, do test. Both cases, identity of tip-giver may or may not be given by doctor.

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I am a dilettante. Neither a doctor, nor a lawyer.

What poisons cause cancer? There must be some, but it's buried in the pertinent literature.

Saccharin (artificial sweetener) causes cancer.
Red meat causes cancer.
Hair spray causes cancer.
Smoking causes cancer.
Bread causes cancer.
Breathing the air causes cancer.
Eating radioactive material causes cancer.
Alcohol causes cancer.
Sex during marriage causes cancer.
Prolonged abstinence from sex causes cancer.
D!ck cheese and yeast cause cancer.
Many other substances, food products, and drinks cause cancer.

Are these all classified as poison?

Listing all the stuff which causes cancer ignores the question posted. There are indeed poisons that cause cancer. Arsenic is one of them. (Interestingly, it is also used to treat cancer). However, X wanted to ask the Doctor because X is not a Doctor. X assumes (I know, I know) that Doctors know more about this type of thing than non-doctors, like X.

X also assumes (I know, I know) that cancer can be caused by many factors, and that a Doctor is looking to treat the cancer, and not necessarily isolate what caused it. However, having been put on notice that there may be a cause that is not one of the many innocuous causes he/she normally sees in his/her cancer treatment experience, the Doctor could look and see if there was anything going on that was not in the normal course of his/her experience.

Hopefully having dealt with that digression, it brings us back to the original question: Can the Doctor be put on such notice without spilling the beans to the patient. The answers that I have received on this thread that go directly to the question asked appear to state the the matter is entirely up to the discretion of the Doctor. Thank you for answering my question.

For the purposes of my book, I followed up with a Doctor who agreed with your position. Indeed, he had experienced a similar situation (not cancer, though), some time ago, poison was ruled out, but the patient was never told about the inquiry because it would have done more harm to the patient and the family support network to inform the patient of the suspicions. He said there was a "social worker" who, even without such suspicions, does a hospice type interview with the patient which goes into available support networks, harmony, etc. Individuals in that network are free to consult with the social worker. According to the Doctor, such interviews are standard in pre-chemo/radiation etc. work ups. Individuals in the network can express concerns and not have those concerns shared with anyone else.

So, Agatha Christi, here we go.

Thank you all for your insight.