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PHL283 Jan 27 2011

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University of Toronto Mississauga
Jonathan Peterson

PHL283 January 27 th Truth Telling - why would a doctor think he’s obligated to withhold information from patients? o cause harm to the patient – depression, suicide o 1. preventing harm – paternalistic reason o 2. patient may not want to know the truth  in order to respect what we take to be the patient’s wishes o 3. patient can’t understand the truth - why should they know the truth? o patients are the best judge of their own values and know the best outcome for themselves – beneficence  the informed patients are the best patients  most appropriate for his/her own life, values  someone that knows more about their situation is more likely to comply with the treatment - if it was widely known that physicians are lying to their patients, the trust in physicians will decline everywhere and people will be less inclined to listen to them o failing to tell the truth would undermine the physician/patient relationship - general respect for autonomy - take from the morally hard decisions from the doctor and give the patient more power - is a recent development that physicians should tell patients the truth about their condition o the culture that values autonomy, the rights movement – advancement in medical technology has made “bad news” not so bad Lipkin - 1. deception is inevitable – whatever the physician tells the patient, there will be some form of deception in it - there cant be an obligation to tell patients the truth because it is impossible o there’s no amount of explaining that can be done to explain to them the medical workings of the situation o it’s a futile effort to try to convey what is happening to them o it can be harmful – have associations with medical terms – has some idea of words mean from popular culture, experiences, kin – the medical terms is likely going to do more harm than good – free association - difference between not understanding and being fed a deliberate lie - the patient will never be able to understand the whole truth – beyond their understanding – but the fact that they can’t understand the whole truth doesn’t give them the license to deceive them o also, you cannot make the judgement of how much they know and don’t know - the fact that they don’t know doesn’t mean they are unable to understand o physicians aren’t taking the time to fully explain - availability for information is widespread – but it depends how the patient interprets it - just because you cant explain the medical jargon, doesn’t mean you cant explain the morally stable argument so that they can make an informed decision about their course of action and treatment - 2. what should guide the patients in terms of access to information? - the crucial question is that in deception, is it intended to benefit the patient or physician? o make sure the lie is beneficial to the patient, not the physician Thomasa 3 factors 1. autonomy 2. beneficence 3. kindness - is it acceptable to interfere with someone’s autonomy now for greater autonomy later - in almost all cases, the physician has the obligation to not deceive the patient - exception to the rule: if the patient has expressed they don’t want to know certain things, then complying with autonomy is respecting their decision to not know - knowing the truth is important because it is a right – knowing the truth is important in exercising your autonomy o knowing the truth is a benefit – helps us to make decisions that will help us in the long run - knowing the truth is “kindness” – important part in sustaining ongoing relationships
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