Mr. Silver

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Mr. Silver is a 39-year-old man with prostate cancer.  Although the disease is confined to his prostate, Dr. Binder knows that, in a patient this young, the cancer is virulent and should be treated aggressively.  For this reason, he strongly recommends that MR. Silver undergo a radical prostatectomy. Mr. Silver has heard about the potential side effects of the surgery including impotence and incontinence, and he insists that he prefers radiation.

            Dr. Bender has explained that the chances of a long-term cure are 30-40 percent better with the prostatectomy and that any resulting problems can be surgically corrected later.  Mr. Silver is adamant, however, saying “Unless you can tell me that the odds are overwhelming that I will not be impotent or incontinent, I’ll take my chances with radiation.”  His wife has told Dr. Binder privately, “I don’t care about the side effects and he’ll get used to whatever happens.  I just want him alive.  We could have many good years ahead of us if he has the surgery.  I’m confused about his decision; it seems so unlike him to take this kind of risk. I’m not sure he totally understands the repercussions of what he is saying.”  Dr. Bender is very uncomfortable with proceeding with radiation.  Dr. Bender wants to respect his patient’s autonomy, but wonders if Mr. Silver is being irrational.

*Post, Blustein, Dubler. (2007). Handbook for Health Care Ethics Committees. Baltimore: Johns Hopkins University Press.