Review of john s colon cancer surgery and


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John, a 20-year-old guy with bowel cancer, underwent surgery in which a significant portion of his significant intestine was removed. Since so much intestinal was taken off, a colostomy needed to be mounted in order for his excretory program to work. The operation was successful, but it is still necessary for John to undergo chemotherapy in order to ensure that no tumor cells will be left.

The problem is that John have been very stressed out since the medical procedures, especially regarding the prospect of wearing a colostomy bag the others of his life. He can not interested in talking to any person about anything at all, including the chemotherapy his doctor wants him to undergo. This individual also is not really open to taking care of his colostomy and the health professional is worried about the possibility of contamination at the colostomy site.

The doctor tried to support John. He previously family and friends make an effort to encourage Ruben and even had a former individual talk to John about how the colostomy have not drastically altered his lifestyle. The doctor is concerned that if this kind of mood is persistant, John could have a difficult, in the event that not not possible, time with chemotherapy.

All this changes when some day, a family member tells John that colostomies can often be reversed. Ruben, ecstatic, demands his doctor why he didn’t talk about this earlier. The surgeon is astonished and confirms and starts to reply, nevertheless is interrupted by David and does not say any more.

John undergoes chemotherapy and a year later, the cancer is fully gone for good. Steve asks a doctor to remove the colostomy. The physician tells him that his colostomy actually cannot be taken off. John replies that it’s okay because he’s learned to live with the colostomy, and is simply glad the cancer’s gone.


There are questions relating to chemotherapy. First of all, we do not know whether John could consent to endure chemotherapy in his depressed condition. It is possible presented his listlessness that this individual decides to refuse conventional treatment, although it is medically necessary and may lead to the cancer coming back. If David does undergo chemotherapy within a depressed express, how could he behave, both physically and mentally? Would his immune system break up (leading to physical damage), or would he include a mental breakdown (leading to mental damage)? The severity of the side effects would determine whether nondisclosure is warranted.

We likewise don’t have a lot of information about John’s reactions. If the doctor truly does disclose the fact that colostomy is not inversible, would Ruben continue to be uncooperative about his colostomy care? It is possible that if this kind of mood persists, infection can happen, which leads to a new slew of harmful unwanted effects. We as well do not know in the event that John is definitely as content with keeping the colostomy as he appears to be. We know that he was depressed, and we don’t know how the chemo offers affected him. If he still is despondent, then this realization need to a mashing blow to him, and he may you should be saying that your dog is okay together with the colostomy, although not actually that means it.

We do not find out much about John’s mental condition. Is usually his major depression impacting his ability to generate decisions and if so , is definitely he capable of making rational decisions? Do not know if perhaps he is receiving any kind of mental health care including counseling by psychiatrists or perhaps antidepressant prescription drugs. We also do not know whether John’s major depression about his colostomy can be regular compared with various other colostomy individuals. This could include affected the surgeon’s decision to not notify John that his colostomy is irreversible, especially provided that the doctor is a specific professional who have likely dealt with similar circumstances in the past and could have before knowledge approach handle the specific situation.

We do not know a whole lot about the physician’s reasons and activities. For example , is the physician genuinely acting inside the patient’s best interests by promoting chemotherapy, or is it possible that he is more worried about with activities such as financial praise? Additionally , the surgeon appears to be the sole medical expert making the decision of disclosure or perhaps non-disclosure, thus would on how he responds have altered if there were other medical personnel in the room with him? Lastly, what was the physician actually gonna say ahead of John interrupted him? Was he planning to tell David that his colostomy has not been reversible, although upon seeing his effect, made a judgment call up not to?

You will discover three guidelines at enjoy in this case: autonomy, beneficence, and nonmaleficence.

Autonomy means that the patient can make his own up to date choice as to what medical procedures his body experiences. In this case, Ruben needs to have all of the facts with regards to his scenario and needs being able todecide whether to endure chemotherapy purposely, freely, and voluntarily. Nondisclosure by the physician regarding the non-reversibility of his colostomy straight impacts John’s autonomy. By simply hiding a fact, the doctor would not allow Ruben to make a fully informed decision. John’s autonomy is also limited by his own depression. His preoccupation together with his colostomy affects his competence and how logical he can become, although the severity of his depression symptoms is not clear. Thus it can be argued that John’s major depression “waives” his right to make his own decisions and so justifies the doctor’s non-disclosure.

The principle of beneficence contains that the singular goal in the physician is always to heal the sufferer. The doctor has to look out for the well-being with the patient, and this case, this involves ensuring that Ruben is cancer-free and psychologically healthy. Coming from a viewpoint of beneficence, the doctor did the right part of not disclosing that John’s colostomy was not reversible. This process led to emotional relief in John, which usually allowed him to undergo chemotherapy successfully and ultimately turn into cancer free. However , it is far from clear whether John is usually content with coping with his colostomy, so his mental well being may be influenced.

Nonmaleficence means that the physician can be not purposely creating harm. In this case, regardless of what the doctor selects to do, you have the possibility of harm. If the doctor does reveal that the colostomy is certainly not reversible, John’s depressed feeling will continue and his colostomy may become contaminated. If he chooses to endure chemotherapy although depressed, this individual could potentially become harmed emotionally and/or literally. He may go through a mental breakdown, or his immune system may be sacrificed. If Steve chooses to not undergo chemotherapy, then the cancers has a potential for coming back. Nevertheless , if the doctor hid this info, John could possibly be damaged psychologically. He may think mental anguish, and the physician-patient trust might be damaged too. There is potential harm in both decisions, but picking non-disclosure leads to less harm than picking disclosure.

Conceivable case resolutions:


  • The doctor corrects David immediately and tells him that his colostomy is definitely not inversible.
  • The doctor is to Steve and tells him that his colostomy is invertable even though it is usually not.
  • The resolution: The doctor does not validate what type of colostomy John provides and enables John to assume that his colostomy can be reversible.
  • We believe this decision is the best choice out of three promises. My debate will be methodized by protecting our resolution against the additional two possible resolutions.

    In a comparison between the resolution and resolution #1, the primary discord is involving the principles of autonomy vs beneficence/nonmaleficence, and beneficence/nonmaleficence must be prioritized over autonomy. We feel that in this case, it is more important for the physician to provide the best care to the patient and steer clear of the most harm than it truly is for the person to make his own decision. We have two reasons for this kind of. First, the actual benefits are greater if the doctor skins the fact that John’s colostomy is not reversible. The chemotherapy will completely remedy John of cancer, offering an enormous physical benefit that is not certain in the matter of disclosure. In the event the doctor explains that John’s colostomy is usually not invertible, resulting in Steve staying stressed out, a slew of negative effects may result. If John decides to undergo radiation treatment, in a stressed out state, there is a high chance that he will probably be harm physically or mentally. In addition , if John is depressed enough, he can likely continue his poor treatment of his colostomy, which might lead to infection. He may also refuse radiation treatment, which provides the chance for the cancer to recur.

    John as well benefits with regards to mental overall health. It is possible (although not certain) that withholding the information presented a way of measuring psychological pain relief and gave him enough time to learn to cope with the colostomy. The patient might experience a lot of psychological suffering from holding out hope that his colostomy was inversible, which may negatively impact the partnership he has with his medical doctor. However , the advantages of non-disclosure still much outweigh the cons.

    Lastly, John’s autonomy could possibly be compromised by his depressive disorder. John is really hung up around the idea that he will have to tote around a colostomy bag throughout his existence that he’s not centered on the bigger goal: beating tumor. His apathy, which may result in him neglecting chemotherapy, implies that he is certainly not fully skilled to make his own decisions. Because John’s autonomy will be limited by his own state of mind, autonomy needs a lower concern than beneficence.

    Inside the comparison among our image resolution and image resolution #2, the real key lies in the between overt lying and deception (withholding information). We hold that deception is actually a better alternate than lying. According to the readings, deception is definitely the “deliberatewithholding of information where the person not educated is tricked into drawing a false summary. ” (Ellin, 78)However, deceptiveness is authorized if a lot of criteria will be met:

  • When the withheld information may be detrimental to medically necessitated treatment. The knowledge that John’s colostomy is certainly not reversible may possibly continue John’s depression as well as cause him to decline medically important chemotherapy. Yet another way of looking at this is that withholding details is ok if that information find yourself injuring the person, and John may experience physical and mental injury if he remains frustrated. This concept is recognized as therapeutic privilege.
  • The withheld information does not improve the patient’s life. The colostomy is definitely not invertible regardless of when the physician explains to John.
  • Therefore , we expect that withholding information is acceptable in cases like this, but overt lying is usually not. One could argue that lying down and deceptiveness are 1 and the same, since they are finished with the same goal and make same result. However , pulling from the Ellin reading, we could argue that “the liar is far more responsible for the harm induced than is definitely the mere deceiver. ” (81) The physician was able to keep back the information since the patient would not ask, therefore part of the fault can be shifted to the patient. In other words, the sufferer is more accountable for bringing about his own deceptiveness than if he had been lied to by the physician.

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