Daniel is a 22 year old with cerebral palsy. He has recently transitioned from care in a pediatric setting, and is reviewing therapies with his new health care team.
Daniel tells the team that he wants to pursue homeopathy instead of continuing regular physiotherapy as the primary means of addressing his symptoms. He claims that physio is not making him better, while homeopathy can result in significant improvement.
This decision raises concerns for the team about his understanding of his condition and of homeopathy, and the team feels that the homeopathic doctor has not given Daniel an accurate representation of the likely benefits of homeopathy. The team is particularly concerned because Daniel is on a limited income as a university student and the treatment is expensive. The homeopath is requesting a copy of Daniel’s medical records.
The team is comfortable with a range of complementary therapies and recognizes that evidence indicates that many of them provide benefit for their patients, but they feel that this situation is relevantly different. Some members of the team are emphasizing the need to maintain a relationship with Daniel over the long term, even if it means supporting suboptimal care in the short run, while other members of the team feel that such an approach would be “unprofessional.”
Daniel has Capacity, but the team is finding it challenging to stand by while Daniel pursues a course of treatment that seems not to be in his best interests based on what they feel are false pretenses. They are wondering if they are obligated to share Daniel’s Health information with the homeopath.
Daniel is taking a course in health care ethics and has requested an ethics consult. He tells you that he hopes you can “convince the team to be more open-minded” and feels that Paternalism influencing their response to his request.
As you open the consult meeting, you establish that the purpose of consultation is not to take sides but to provide a forum for discussion. You choose to start with eliciting Daniel values and reasoning because you want to give priority to the patient perspective, recognizing that often the patient is more vulnerable than others around the table OR you start with reviewing the team’s values because the manager jumps in as soon as you finish summarizing the case.