REM sleep behavior disorder (RBD) is a parasomnia, i.e., sleep disorder occurring during REM sleep, characterized “by vivid dreams associated with dream enactment.” This enactment includes; “abnormal vocalizations, motor behavior, and dream mentation, yelling, screaming, failing limbs, punching, kicking etc.” (Boeve). Additionally, individuals who have the disorder are not aware of these abnormal behaviors during their sleep, they only come to know them from their bed partner. Now, what is crucial to note about RBD, is that in many cases, an individual is diagnosed with RBD before later being diagnosed with an a-synucleinopathy (e.g. Parkinson, dementia with Lewy bodies). In other words, after being diagnosed with RBD, an individual is at a …show more content…
male’s risk of injury to others, his desire for confidentiality, and disclosing the risk of developing a neurodegenerative disease in the future. Furthermore, for the purpose of this essay, I will refer to the bed partner as the patient’s wife. As the case from the reading, “Ethical considerations in REM sleep behavior disorder” depicts, the risk of harm to others can be high. In the case described, the wife had bruises on her arm and leg as a direct result of her husband’s RBD (Vertrees). While it is not explicitly stated in the present case that the wife has any bruises, it can be implied since the case states that there is smothering and punching. Due to the fact that there is smothering and punching the risk to others is high. Now, the ethical issue here is, the duty to uphold patient confidentiality v. the safety of the patient’s wife. On one hand, if I as the physician chose to disclosure the patient’s RBD diagnosis with the wife, that disclosure may erode my patient’s trust and thereby have a detrimental effect on the doctor-patient relationship. Furthermore, the patient may not want to come back to see me for follow-ups. However, if I …show more content…
To disclose a diagnosis is to inform a patient that they have a specific disease, disorder, or condition. To disclose a risk is to inform a patient that they have a chance (whether that be highly likely, or highly unlikely) of developing a specific disease, disorder or condition sometime in the future. The problem with disclosing a risk is uncertainty. However, people have to make decisions without certainty all of the time and that alone should not stop a physician from disclosing a risk. Now, there are several arguments for disclosing a risk of developing a neurodegenerative disease. Some of these arguments are captured in Vertrees’ article. This includes; respect for autonomy (and within autonomy informed consent), the patient finding out on their own, not disclosing could affect the doctor-patient relationship, truth-telling, allow for the patient to put their affairs in order and alerts the patient and the patient’s loved ones to watch for the onset of symptoms and having the possibility to receive early treatment. While these are all arguments for disclosing risk, there are also arguments against disclosing risk. This includes; the possibility of disturbing the patient’s current life, the patient worrying and living with anxiety awaiting the onset of a neurodegenerative