Ethics in decision making and patient autonomy.

Kahana, the diagnosis was late, and we don’t know whether timely investigations (CT scan, fiberoptic bronchoscopy, etc) at the first onset of thoracic symptoms might have changed the course. But, certainly, hemoptysis is not an underevaluable symptom, especially in smokers or former smokers . 40 years of age, even with normal chest radiographic findings, as also shown.2– 4 Reporting his case, Dr. Kahana has given us the opportunity to remember that (1) former smokers are not completely risk free, even though they stopped smoking a long time ago; (2) some tumors grow slowly, may manifest dramatically after several months from the first clinical or radiographic appearance, and they cannot be readily related to lung cancer (which may, perhaps, have happened to Dr. Kahana); (3) when an incidental chest radiograph shows opacities not previously known in asymptomatic patients, especially in smokers or former smokers, lung cancer should be first suspected and further investigations carried out; (4) an apparently complete or good clinical response to antibiotic or steroid therapy should be confirmed by a radiographic followup; and (5) diagnostic procedures revealing doubtful results should be repeated within a short time.