One of the big science stories recently was about US doctors and scientists infecting Guatemalan prisoners and mental patients with syphilis to carry out research.  This made me realise that scientific and medical ethics is something that I’ve neglected to really comment on.  I’ll be trying to rectify that and this post is part of that effort (although it doesn’t deal with anything as unethical as the Guatemalan experiments).

I’m currently reading “Phantoms in the brain” (by VS Ramachandran and Sara Blakeslee) and the description of the treatment received by one of Ramachandran’s patients had me pondering some questions about medical ethics.

The case involves a patient who Ramachandran diagnoses with Capgras syndrome.  This is a disorder in which a person believes that a close friend or relative has been replaced by an identical-looking imposter.  The patient in the book believes this of his parents following a head injury.

Having made his diagnosis, Ramachandran does not tell the patient “because I wasn’t sure how he’d react”.  However just a few pages later we read the following poignant passage:

“Arthur’s most serious problem, however, was his inability to make emotional contact with people who matter to him most – his parents – and this caused him great anguish.  I can imagine a voice inside his head saying, ‘The reason I don’t experience warmth must be because I’m not the real Arthur.’  One day Arthur turned to his mother and said ‘Mom, if the real Arthur ever returns, do you promise that you will still treat me as a friend and love me?'”

Given Arthur’s distress is it really ethical for his doctor not to reveal his diagnosis?  The news that there are others who share this problem with him could help ease that distress.

As we are not his doctor and don’t have access to the full facts of the case there is no way for us to know.  Nevertheless it would have been good if the book had answered this question for us rather than leaving us speculating.