The New York Times published an article titled “A Life-Death Predictor Adds to a Cancer’s Strain” or, alternatively, “Genetic Test Changes Game in Cancer Prognosis.” The piece is interesting on several levels, but, to me, serves to highlight an increasingly common ethical conundrum: are physicians obligated to seek knowledge that is available but has no possible medical benefit?
Most of us are familiar with the Schrödinger’s cat thought experiment (the basic setup: a cat is placed in a box, along with a device that has a 50/50 chance of killing it within the hour). Suppose Schrödinger decided to actually carry out this experiment and you happen to be the veterinarian for the poor soul whose cat he borrowed. Having been rushed to the scene by a distraught owner, you are faced with a choice: open the box and reveal the cat’s present state of health or wait and let the cat reveal itself by its eventual demands to be let free (or lack thereof).
Where my story runs parallel to real life: at the point of decision, Schrödinger’s veterinarian and the physician have no power over the patient’s outcome. Their professional capacity as healer has been exhausted. The cat is either dead or alive. The patient has Class 1 or Class 2 ocular melanoma (and its attendant mortality). Until the proverbial box has been opened, however, neither state of affairs has quite come to pass. The patient is neither doomed nor saved. The physician stands as the portal of knowledge, holding the key that could dispel fear but also kill hope.
Typically, patients just want the good news. In a perfect world, only patients with the treatable Class 1 melanoma would have the test performed. Their Class 2 counterparts, on the other hand, would avoid it and preserve their hope until the end. Unfortunately, this perfect world requires physicians with prescience (or an ethics “flexible” enough to perform the test without the patient’s knowledge).
What, then, of our imperfect world? Is the possibility of relief worth the risk of a death sentence? Further, what is the physician’s role in answering this question? It is my belief that the option must be presented. The decision to know or not know is deeply personal. Once he has stepped outside of his role as healer, the physician has no expert knowledge to justify any form of paternalism. While he can serve as counselor, interpreter and friend, the physician has no right to decide if the possibility of finding a dead cat is worse than waiting next to a terrifyingly silent box.