Reference no: EM132254709

Huntington's chorea is a genetically transmitted disease that affects both males and females. Only one gene from either parent is required to transmit the disease to offspring. If a person knows that the disease runs in his family, there is a 50/50 chance that he will have it. Although some tests have been developed to detect the disease, generally people will not know that they have it until the symptoms appear, generally in midlife. In the United States, one person out of 10,000 has it. Thus, there are over 20,000 active cases in the United States, and there are probably 100,000 people who are uncertain whether they have it.

With Huntington's chorea, there is a continuous and irreversible deterioration of the mental, physical, and motor functions. Clumsiness and forgetfulness are followed by angry outbursts, disorientation, incontinence, loss of speech control, and writhing and twisting of the entire body. Ten or twenty years of suffering lead to death. Victims often commit suicide.

Dr. Calvin discovers that Mary X., age 40, has Huntington's chorea when she comes to ask for help with her memory loss and angry outbursts. He does not tell her the truth because there are no medical decisions to be made, but most of all because of the horrible death she faces. A few weeks later, when Mary's son, age 20, comes in for a premarital blood test, Dr. Calvin wonders if he should tell the son that he has a 50 percent chance of having the disease and so should hesitate about having children.

Is the physician ethical in concealing the truth? Does Mary need to know the diagnosis for any possible decisions about herself and her children? What is the Significance of the fact that she has paid for the diagnosis? Could the physician's silence be justified by paternalism or therapeutic privilege? What is to be said of the argument that, since there is no treatment, there is no need for informed consent?