Telling Patients the Truth
When, if ever, are HCPs justified in lying to patients, or in not telling the whole truth?
Connected with consent – failing to tell patients the truth undermines consent.
Lying and Withholding Information:
In everyday life there may be an important difference between direct lying and
withholding information – the former seems morally worse than the latter
In medicine, the difference is not so great. The health care provider is under a special
obligation toward patients, which does not apply in everyday life. Withholding info in
HC is, therefore, much more like direct lying.
Danger of SelfDeception in HC
Health care providers may be under pressure to deceive themselves about whether the
interest of the patient requires them to withhold information from the patient.
SO, it is very important for health care providers to be honest with themselves.
Radical Change in Medical Practice
1961 – A survey indicated that 90% of physicians would avoid telling patients the truth
about a diagnosis of terminal cancer
1980 – By this time more than 90% of physicians do inform patients of terminal cancer
Part of the reason for the change may be more effective treatments for cancer
Temptations not to tell the truth:
Cases of terminal illness
A colleague is drunk on duty, makes mistakes
A single mother wants you to say she is unwell so she can stay home to care for
her sick child
To tell a child that a painful procedure won’t hurt
Student asks for reference for a job he didn’t do
An exhausted daughter wants you to tell her father that she’s medically unfit to
care for him
How much should the patient be told about the side effects of the drug he’s
Justifications for telling patients the truth:
Strong presumption in favour of telling the truth
Lying requires a very special justification
The presumption can be justified on both
1) Util grounds – imagine where we would be if could not depend on people to
speak the truth
2) Kantian grounds – treating someone with respect generally requires telling them
the truth Common Reasons for Lying in HC
1) Impossible to tell the whole truth – it’s too complicated and there’s too much info
2) Doctors don’t know the whole truth – there’s too much uncertainty in medicine
3) Patients may misinterpret info they are given
4) Some patients don’t want to know the truth
5) The naked truth may be harmful to patients
6) Withholding info will often help a patient – ie placebos
Objection 1: Patient Inability to Understand
Reply: Important for HC providers to recognize that they have an obligation to try
hard to provide patients with as much accurate info about their condition as is feasible –
this is part of the job. In most cases it can be done.
Objection 2: Doctors Don’t Know the Whole Truth
Reply: Of course, doctors often don’t know the whole truth – there are many
uncertainties. But this is no reason to withhold info the doctor does possess. In such cases
patients should be informed as accurately as possible of these uncertainties.
Objection 3: Patients May Misinterpret Info
Reply: This is an ev