Sharing information with family members
Ray, a 19 year old man, had a motorcycle accident and suffered a serious head injury. He was taken by air ambulance to a Major Trauma Centre where he was stabilised, admitted to the Intensive Care Unit and placed into a medically-induced coma. Dr Wachuku is the consultant in charge of Ray’s care.
Dr Wachuku has encountered a difficult situation with Ray’s divorced parents, Tina and Joe.
Joe has been calling Tina and the hospital to ask about Ray, and wants to come in and talk to Dr Wachuku.
Tina is very angry and upset about this. She and Joe divorced acrimoniously when Ray was just a baby, and Joe had no involvement in Ray’s life until a couple of months ago when Ray decided he wanted to get in touch with his father.
This was very much against Tina’s wishes. Tina explains all this to Dr Wachuku and says she doesn’t want Joe to visit Ray in hospital and ‘play the caring father’.
She also insists that Dr Wachuku shouldn’t tell Joe anything about Ray’s medical condition, because he has no right to know.
As Ray was unconscious when admitted to hospital, Dr Wachuku cannot be sure whether he would want his father – or indeed his mother – given details of his condition.
However, Dr Wachuku thinks that, all other things being equal, it is reasonable to assume that Ray would want those close to him to be treated with consideration and kept informed.
While Dr Wachuku is mindful of his duty of confidentiality, he is equally concerned that he should not meet concerned relatives with a wall of silence.
Tina’s request not to give her ex-husband any information about Ray’s condition puts Dr Wachuku in a tricky position.
While he doesn’t want to cause her any unnecessary upset, on the basis of the little he does know – that Ray has recently re-established a relationship with his father – he has at present no obvious grounds to think that Ray would object to Joe being kept informed.
The decision will ultimately be Ray’s if and when he regains consciousness and capacity. But in the meantime, Dr Wachuku has to decide how to manage the situation in a way that is sensitive to Tina’s feelings.
What the doctor did
Dr Wachuku acknowledges that this is already a very difficult time for Tina and that the idea of Joe’s involvement is adding to her distress.
He explains to her that he has a professional responsibility to be considerate to his patients’ relatives, and as there is no reason to suppose that Ray himself would object, he will continue to give Joe general updates on Ray’s condition and prognosis.
He also explains that he cannot prevent Joe from visiting if he chooses. However, he also confirms that he will establish Ray’s own wishes on the matter, as soon as it is possible to do so.
Later, Dr Wachuku reflects on whether he would have handled the situation differently if there had been no recent father/son contact.
He concludes that, while this could increase the possibility that Ray would object to information being disclosed, he would still not be able to justify refusing to engage at all with Joe, as Tina wishes him to do.
What the doctor had to consider
- Doctors have a duty to be considerate to those close to their patient and to be sensitive and responsive in giving them information and support, while respecting the patient’s right to confidentiality (paragraph 34).
- Where possible, doctors should establish with the patient what information they want shared, with whom, and in what circumstances. This is particularly important if the patient is likely to lose capacity to make decisions, or their capacity is fluctuating (paragraph 36).
- If a patient lacks capacity to decide, it is reasonable to assume they would want those closest to them to be kept informed of their general condition and prognosis, unless they indicate, or have previously indicated, otherwise (paragraph 38).