Should you tell patients about beneficial treatments that they cannot have? No

doi:10.1136/bmj.39171.511794.AD

BMJ 2007;334:827 (21 April), doi:10.1136/bmj.39171.511794.AD

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Head to head

Should you tell patients about beneficial treatments that they cannot have? No

John Firth, consultant nephrologist

Addenbrooke's Hospital, Cambridge CB2 2QQ

jfirth@doctors.org.uk

No healthcare system can afford to pay for all available treatments.Robert Marcus believes doctors have a duty to tell patientsabout unfunded drugs, but John Firth argues that it will causethem harm

The first 150 words of the full text of this article appear below.

I am a kidney doctor. Mr Brown, a frail 79 year old man wholives in social housing, comes to my clinic. He has advancedchronic renal failure, cause unknown, but not so far advancedthat dialysis would be likely to benefit him, and in previousdiscussion with me and the dialysis nurses he has said thathe doesn't want it in the future anyway. He tells me that heis tired, has no energy, and getting around is more of an effortthan it used to be, but he is eating satisfactorily and hisdiagnosis is that he thinks he's getting old. His haemoglobinis 101 g/l.

I suspect that he would feel better if his haemoglobin was higher.He is not iron deficient. Erythropoietin would be the most appropriatetreatment on clinical grounds and likely to be successful. Suchtreatment agrees with the current guidance from National Institute. . . [Full text of this article]

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Relevant Article

Should you tell patients about beneficial treatments that they cannot have? Yes: Robert Marcus
BMJ 2007 334: 826. [Extract] [Full Text] [PDF]

This article has been cited by other articles:

Perry, J. (2007). Patients do not live in an information vacuum. BMJ 334: 915-915 [Full text]
Kyle, G. (2007). All that is needed is for good men to say nothing. BMJ 334: 915-915 [Full text]

Rapid Responses:

Read all Rapid Responses

Acknowledgement: John Firth
bmj.com, 20 Apr 2007 [Full text]
Is Mr. Brown in an information vacuum?: John Perry
bmj.com, 20 Apr 2007 [Full text]
Duty of Candour: Som Prasad, et al.
bmj.com, 21 Apr 2007 [Full text]
Naivety or Conflicts of Interest?: Jay Ilangaratne
bmj.com, 22 Apr 2007 [Full text]
What about obligations to sick friends or colleagues?: Anonymous Health Professional
bmj.com, 24 Apr 2007 [Full text]
Rationing by ignorance denies patients their fundamental rights: Gerhard B. Holt
bmj.com, 23 Apr 2007 [Full text]
Physicians as gatekeepers: Luis Justo
bmj.com, 23 Apr 2007 [Full text]
All that is needed is for good men to say nothing: Graham Kyle
bmj.com, 24 Apr 2007 [Full text]
Re: Rationing by ignorance denies patients their fundamental rights: Jay Ilangaratne
bmj.com, 24 Apr 2007 [Full text]
The inverse care law working again: peter b hadfield
bmj.com, 25 Apr 2007 [Full text]
Flawed example: Martin Gerken
bmj.com, 3 May 2007 [Full text]
Happiness: Andrew Montgomery
bmj.com, 4 May 2007 [Full text]
Further comments on obligations to inform patients about treatment options: John Firth
bmj.com, 6 May 2007 [Full text]
Not the doctor's choice any more?: Steve Choong
bmj.com, 6 May 2007 [Full text]
Ethics 101: Andrew Montgomery
bmj.com, 8 May 2007 [Full text]