I am 100% on the other side of an ethics question recently raised for the New York Times’ ethics advice maven, “The Ethicist.” You tell me which of us you think is right.
Details aside, the inquirer asked if he should, as a retired neurologist, tell a woman he admittedly barely knows but whom he has been in frequent contact with recently that he believes she has Parkinson’s Disease…
….There’s been no occasion to mention my professional background, and I’m now uncertain about whether I should tell her about it and my clinical impressions. Her disease, at its current stage, is likely to be successfully managed with oral medication. However, it is neither obvious that she will have access to skilled neurological care nor that she will be willing to seek it. And a new diagnosis of Parkinson’s, without prompt treatment, on top of her recent loss and the challenges that have followed, may further overwhelm her. My wife is in favor of my informing her, because treatment would benefit her quality of life. I’m hesitant, as there has been no invitation to become more involved in her personal life, and I cannot provide her with a supportive doctor-patient relationship. What would you recommend?
I’ll tell you which of us ethicists believe what after you’ve formulated your own answer. For now, Your Ethics Alarms Ethics Quiz of the Day is,
What would YOU recommend?
The NYU philosophy prof’s answer was that the retired neurologist should offer his diagnosis, unasked. “As a former professional in the field, you’re in a position to reduce that risk by advising her how to access the necessary care, ” Kwame Anthony Appiah writes. “Treatment that could help alleviate her symptoms would be the best outcome. Surely you would want to know if you had a treatable medical condition.”
I take a different view, perhaps as a result of my view from a different perch. Lawyers are not supposed to hand out unsolicited legal advice (it can make you an individual’s client and get you sued), and practicing law without a license is a serious ethics offense. If the inquirer is a retired neurologist, then presumably he isn’t one any more. Maybe the field has advanced since he last practiced. Maybe the woman’s symptoms now may indicate something other than Parkinson’s, thanks to new research. The point is that she hasn’t asked him for his opinion. I have no problem with his suggesting, in a kindly, unobtrusive way, if she’s seen a doctor lately and if not, would she appreciate a referral. That, however, is as far as I deem it ethically correct for him to go.
“The Ethicist” is relying on Golden Rule principles to reach his conclusion, but reciprocity requires that one can accurately gauge what the person you are preparing to do unto would want. Funny about that: I certainly don’t want unsolicited diagnoses from retired doctors, dentists, psychiatrists or surgeons who don’t know me well and who have never formally examined me. I was leaving an airplane after a flight ended one time, and a fellow passenger tapped me on my shoulder as everyone was gathering their luggage and clothes. “Excuse me,” he said, “but I couldn’t help but notice that your earlobes have distinct creases in them. I’m a heart specialist, and recent studies suggest that that is a sign of increased risk of a genetic tendency for serious heart disease.” “Gee, thanks!” I said, leaving out the accompanying “Asshole!” in my unspoken thoughts. As it happened I had seen that study, and my long-time personal doctor had told me that it was probably hooey, and that anyway, he was checking my heart condition regularly, so creases in my earlobes were not worth worrying about. The conversation with the buttinski passenger was 40 years ago. No heart problems yet!
Not only is “The Ethicist’s”–I put his title in quotes because in these parts, I’m The Ethicist, dammit!—-advice not supported by reciprocity, I’d say that Mr. Kant wouldn’t support it either. I doubt that he, or you, and certainly not me, would prefer to live in a world where every expert or alleged one felt compelled to hand out unsolicited diagnoses, advice and guidance without being asked. Yes, support for Appiah’s position might be found in a utilitarian approach, but even that assumes a lot—too much, in my view. How do we know how astute this former doctor is? How closely has his incidental contact with the woman covered the ground of a genuine, thorough, examination? How well does he know how the woman would handle such an ominous warning? How does he even know that the woman isn’t already being treated for Parkinson’s? To conclude that the beneficial results of his gratuitous diagnosis would exceed its possible drawbacks seems to me to require far more data than “The Ethicist” was provided.
Heck, maybe she’s wondering whether to tell him that he reminds her of Joe Biden and may have dementia….
Ethics Alarms 
I was going to say no but I really could not articulate the reasons for why I said no. The best I could come up with was without a proper examination, no doctor should offer an opinion on a condition that, one, he cannot say with some diagnostic evidence from such an exam that a condition exists. Two, he does not know if she is being treated for something else that may be causing symptoms that mimic Parkinsons.
I am not sure I would even offer a referral unless asked. To do so would mean that I would have to explain why I thought the referral was warranted which might prove embarrassing to the other person.
Sometimes the answer is found by asking a different question.
Imagine a retired doctor suggesting your neighbor’s wife should try semaglutide. Why not just call her obese. Should he do it? NO.
I wonder if this follows in a similar field of offering a woman congratulations on being pregnant if you don’t know if she’s pregnant? If you’re wrong, how embarrassing for both of you.
And yet, if I didn’t know and someone said, “Hey, I used to be a obgyn. I think you might be pregnant, I might want to go out and get a test to be sure and might be grateful on either result.”
Granted that’s just me. I also understand most people would rather I just mind my own business.
Disagree. If my hair stylist notices a funny looking mole on my scalp I would want her to say something. Likewise, if a few words from the retired neurologist can help the lady I don’t see how it could be unethical for him to say something.
Yes, it isn’t ethical to offer an unsolicited, no-exam diagnosis. But, by the Golden Rule, it feels right to ask if the person is under medical care. A bit like, someone on the plane tells you about something and you say ‘I wonder if that is something a lawyer could help you with?’ Or would that still be unlawful practice of law? I feel there is a issue here of ‘the false binary’ – the idea that the only alternative to saying too much is saying nothing. Often there are other ways.
Some other “cases” (terrible pun intended) for your consideration: https://www.irishtimes.com/news/politics/noonan-not-first-td-to-have-a-condition-diagnosed-on-live-tv-1.2108764
and there is this:
https://www.npr.org/2022/01/03/1069935191/canucks-manager-skin-cancer-fan-scholarship
-Jut
No, I think Jack’s approach, asking the woman if she has seen a doctor lately and if not, asking if he can give her a name, is the best. I really dislike people trying to manage my life or tell me what they think I should do. My mom was the worst at that. If she started a sentence with “my friend tells me a new study says…” then you knew you were going to be told to make some change in your life that you might not necessarily want to. Of course she herself hadn’t read the study, and who knows if her friend really understood it, but if it gave her leverage to tell someone to do something or stop doing something, that was good enough for her. That and recommending movies because “my friend said it got really good reviews.” She hadn’t read the reviews. It was just another way to tell someone else to do something they might not want to do otherwise. Honestly, the only adults who should be telling other adults to do anything are those in black robes, those with badges, those who are signing those other adults’ paychecks, or those who are being paid by those other adults to give an opinion on a course of action. Everyone else should zip it.
“I really dislike people trying to manage my life or tell me what they think I should do”
In these here parts we call ’em the We Know What’s Best For You crowd, and the 77 Square Miles Surrounded By A Sea Of Reality is crawling with them.
“(For) our own good (they’ll) torment us without end for they do so with the approval of their own conscience.” C.S. Lewis
PWS
I hit the paywall, so am operating on limited context.
The story reminds me of a subplot from a Scrubs episode, whether Doctor Cox briefly interacted with a rival colleague and his young son. Cox thought something was off about the boy, and suspected autism. He offered to babysit, and after a longer interaction with the boy, became concern enough to voice his opinion to the father that a formal evaluation be done. The colleague reacted with initial denial, accusing Cox of jealously, but eventually accepted the advice, and got the son evaluated, and was able to begin early intervention.
The story above is fictional, but illustrates one potential path the real-life situation might take. Obviously a retired neighbor shouldn’t purport to take a whole examination without consent of the other neighbor. However, his ethics alarms were ringing because of his observation. A simple statement explaining the symptoms of concern, briefly explaining he is a retired doctor in that field, seems like a reasonable resolution.
As neighbors, there is a preexisting relationship, however narrow. One would reasonably appreciate a neighbor saying he saw a branch falling on the roof, or calling the police if someone were snooping around the yard after dark. Neighbor’s do this all the time, checking on the elderly or sick after a storm or power outage. Pointing out a health concern to someone you speak to regularly, and recommending he or she get it checked out is only slightly more invasive.
That regular contact makes the situation materially different than the nosy doctor pointing out a funny earlobe pattern, and more like the stylist noticing a new mole on the head of customer she saw regularly. After expressing such concern, his neighborly duty would be done, it would then be in the neighbor’s court what to do, if anything, with that advice. How open the other neighbor was to the advise would dictate the appropriateness of any follow up.