The PLoS Medicine Debate

The PLoS Medicine Debate The PLOS Medicine Debate discusses important but controversial issues in clinical practice, public health policy, or health in general. Debates will be commissioned from two or more authors with differing points of view.

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Should Informed Consent for Cancer Treatment Include a Discussion about Hospital Outcome Disparities?

  • Nadine Housri,
  • Robert J Weil,
  • David I Shalowitz,
  • Leonidas G Koniaris
  • Published: October 21, 2008
  • DOI: 10.1371/journal.pmed.0050214

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New York Times coverage of this debate

Posted by plosmedicine on 31 Mar 2009 at 00:33 GMT

Author: Andrew Hyde
Position: Publications Manager
Institution: PLoS Medicine
Submitted Date: January 06, 2009
Published Date: January 6, 2009
This comment was originally posted as a “Reader Response” on the publication date indicated above. All Reader Responses are now available as comments.

Should patients be told of better care elsewhere?

In October PLoS Medicine published a debate that posed the question "Should Informed Consent for Cancer Treatment Include a Discussion about Hospital Outcome Disparities?"

The debate examined the ethical dilemma of whether a surgeon treating patients with cancer whose treatment results are not as good as those at another, more distant hospital, has an ethical obligation to tell to his or her patients about this. Leonidas Koniaris and Nadine Housri took the view that physicians do have an ethical duty to inform patients of these outcome disparities; Robert Weil and David Shalowitz contributed other points of view.

The debate has now been used in an article by Denise Grady in the Health Section of the New York Times [ ]. This article also asks if patients should be told of better care elsewhere. Starting from the example of the experience a relative of the journalist who had rectal cancer, it proceeds on to a discussion of each point of the debate.

Leonidas Koniaris and Nadine Housri - at the University of Miami - argue that the experience of the medical team is especially important in major cancer surgery, and, interviewed by the journalist, Koniaris confirmed that he has informed patients about other doctors who have better results treating pancreatic cancer and liver tumors.

The article also outlines the point of view of Shalowitz, a bioethicist, who says that this obligation to disclose information about other medical centers would lead to untenable conflicts of interest. It also mentions the hurdles that Robert Weil, a neurosurgeon, in the debate said complicate the question of comparing hospitals.

The journalist ends by mentionig US government websites that compares hospital performance in treating certain illnesses (www.hospitalcompare.hhs.g...) and another that lists hospital infection rates in states that make this information available (http://www.hospitalinfect...).

URL of the New York Times coverage:

No competing interests declared.