Not Knowing What You Don’t Know: Is Ignorance Ever Bliss?

As I see it, there are two aspects of “not knowing what you don’t know” as applied to health and medicine. One is related to the behavior of the physician and the other is related to the behavior of the patient.

A physician who does not know what information is missing from his or her medical knowledge or understanding may be diagnosing and treating patients with a mental blinder. Doctors simply cannot know about everything clinical and indeed there is some information that is simply unknown to all professionals but all physicians should be aware of these unknowns. A physician assuming that he or she is aware of some knowledge but doesn’t really know is in fact performing guessing and then to proceed without being aware of one’s ignorance of some element of diagnosis or treatment can cause damage to the patient through possible subsequent error. Also without knowing what the doctor doesn’t know, the doctor can be delaying a consultation on the case by a physician whose medical knowledge is more complete in the particular information.

How does “not knowing what you don’t know” apply to the behavior of a patient? It does apply but in a different meaning and context than that of the physician but can be just as potentially harmful to the patient.

A person who is without symptoms and is unaware that they have tuberculosis may be made aware of the disease by skin tests and chest x-rays. If that person would agree to take these tests as an appropriate screening the person would then know and could be promptly treated. But what if a patient doesn’t want to know what is yet unknown to the patient? If a patient has trouble swallowing but fears that cancer is the cause, the patient may elect to delay going to the physician for a diagnosis, fearing the worst. By “not knowing” what is yet an unknown there may be some temporary comfort to the patient by the ignorance than being aware of the diagnosis of cancer, if present, but that would be delaying final diagnosis and treatment of whatever was causing the symptom.

I have written above that either the doctor or the patient “not knowing” can be harmful. Are there any reasons in either application of “not knowing what you don’t know” to the physician or to the patient could be accepted as something appropriate and an ethical “good”? Is ignorance ever bliss? ..Maurice.

A Taste of Pain and Suffering and the Role of the Physician

Should every human taste some individual pain and suffering so as to gain a better perspective of their own life? Can we agree that we will better understand our good life if we suffer a little?

The medical profession has always had its goal aimed toward the relief of pain and suffering. But is that really a professional action that is ethically untouchable? Could there be times when it would be to the patient’s benefit and good for the physician to allow some pain and allow some suffering? Should it be the physician's decision as to when to permit that pain and suffering? I await your response. ..Maurice.

p.s.- I posted the same issue on Medpedia. You might want to go there to read the responses there as they are made.

Who Should Assist in "Assisted Suicide": Doctor or Family?

Think about a chronically ill patient who is suffering, debilitated and can't seem to get relief. Think about the patient with an end-stage cancer who is not obtaining relief of suffering from established medical treatments. Suppose these patients ask their doctor to "help" them die and end their suffering.

In the United States, only two states, Oregon and Washington, permit, under restrictions, physician assisted suicide. Physicians can prescribe a lethal dose of pills that the patient can take by themselves at their own time if they desire. Despite the two states laws allowing physician assisted suicide, there is, I think, ethical reasons why physicians should not be doing this.

But what are the ethics of assisting a patient in their act of suicide? Should society really allow this generally as it has in the two states, by physicians and with requirements? But why physicians? By assisting in suicide, wouldn't they be violating professional principles? Wouldn't they be degrading the professional trust that society has expected from doctors? Wouldn't this lead to physician encouragement for suicide rather than the patient electing end-of-life palliative care?

Why not allow family to assist their suffering family member in the patient's own wish for suicide? The family members who assist have no professional oaths to uphold. Is there concern that family members who have attended and cared for the patient and now tire will have their own personal interest to accelerate the patient's death?

Any suggestions for the answer the question: Who should assist in "assisted suicide": Doctor or Family? ..Maurice.