Alexander Pope once stated in An Essay on Criticism “A little learning is a dangerous thing” (updated in modern times to the saying A little knowledge is a dangerous thing).
Here’s a conundrum.
Benjamin Dover has lymphoma and is a candidate for a bone marrow transplant. Ben is 10 years old. His parents, Mr. and Ms. Dover agree to be tested to see if either might be a suitable donor. Dr. Smith, the patient’s pediatric oncologist, spearheads the process.
When the lab results return, Dr. Smith learns that neither parent would be an ideal candidate. Dr. Smith also learns from the genetic testing that Mr. Dover cannot be Ben’s biological father.
Mr. and Ms. Dover have been married for 15 years, and by outward appearances, seem to have a close and loving relationship. Further, Ms. Dover did not express any anxiety about the genetic testing.
Dr. Smith does not believe either Benjamin or Mr. Dover knows who the actual biological father is. In other words, Dr. Smith suspects there’s a secret that has been kept for a long time – but is not sure.
What to do?
(1) Simply report back to the parents that neither was found to be an ideal donor?
(2) Approach Ms. Dover privately and explain what was learned? See if Ms. Dover is open to locating the biological father to see if he’d be tested as potential donor?
(3) What about the medical records? What it it states that Mr. Dover has no genetic overlap with Ben?
There’s no perfect answer to this. Any answer involving multiple parties will necessitate compromise of one or more ethical principles.
On the one hand, Ben is the patient. Dr. Smith should advocate for her patient. That means, do everything possible to find a suitable donor. The good news is that in 2014, there are tissue banks that make it easier to find bone marrow donor matches. And donating bone marrow is not a “disfiguring process.” So, Dr. Smith could conceivably just report – “Neither of you are good donors. Let’s see what the tissue bank has.” But, what if Ben needed a kidney, and not bone marrow?
Ms. Dover is central to the drama. It probably makes good sense to privately bring her into the discussion. But, she might request that Dr. Smith not share her secret with Ben or Mr. Dover. OK. Not unreasonable. Ben’s the patient. And the information might cause familial discord. Mr. Dover might freak out. Ben might freak out. Not the best environment for treating cancer. Maybe Dr. Smith and the mother agree to keep the secret. But, what happens when Ben turns 18 and asks the good doctor lots of questions?
Also, once Ms. Dover is aware her secret is out, should Dr. Smith prod her to see if the biological father might agree to be tested for possible donor? If so, are there more secrets to be kept?
What is either parent wants to see the full medical record? The parents take the record to another doctor – who opens his mouth in an uncontrolled setting – “Hey, I never knew Ben had another dad?”
This vignette illustrates the challenges faced by information learned collaterally. Alexander Pope was right. Sometimes a little learning is a dangerous thing.