chapter 5 truthfulness.docx

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Biological Sciences
Danillo Viana

Chapter: 5-Truthfulness 1 Truthfulness and Truth-Telling in Health Care - The health professions expressed little concern for truthfulness in their ethical code and are indeed somewhat unique with respect to norms of truth-telling - Truthfulness was assigned a subordinate place in relation to benefiting the patient and preventing harms - In the first place, being truthful w/ patients is less associated w/ harm than it used to be o Ex. Pts who are gravely ill  There is a greater recognition of the therapeutic benefits of information disclosure in general - Pts have the right to know the truth, even if disclosure is likely to be harmful Arguments For and Against Truthfulness in Health Care - The main arguments on either side of the issue depend on how one situates truthfulness in relation to two other values: 1. Beneficence 2. Respect for autonomy 1. Truthfulness and Beneficence - The main argument given in defence of limited disclosure and even deception is that health professionals have a duty to prevent harm to patients and telling the truth may very well cause harm - If a disclosure will have harmful consequences, truth-telling is indeed at odds with beneficence (or non-maleficence) - Informing patients in a “sensitive and tactful fashion” is important o To the extent that disclosure may have harmful consequences, the harm can be minimized, if not avoided altogether, by the development of a thoughtful and sensitive bedside manner - Disclosure makes it possible for patients to express their feelings, ad this alone may have therapeutic values 2. Truthfulness and Autonomy - Those supporting greater openness and disclosure tend to focus on respect for autonomy - ANA-states that o “truth-telling and the process of reaching informed choices underlie the exercise of self- determination , which is basic to respect for person  ANA claims that clients have the moral right to determine what will be done with their own person; to be given accurate information and all the information necessary for making inform judgment - Patients require adequate and reliable information - Truthfulness also promotes autonomy by helping patients to maintain a sense of control over their lives Chapter: 5-Truthfulness 2 - On the other side of the issue, it is sometimes given as a justification for deceiving or withhold information that some patients, particularly when the medical problem is severe or fatal do not want to know about their condition o In such cases, telling patient the truth maybe not only harmful but would also fail to respect their autonomy 3. Truthfulness, Trust, and the Practitioner-Patient Relationship - Arguments based on beneficence, autonomy and practitioner’s obligations in the practitioner- patient relationshipfavour of openness and disclosure - Practitioner-Patient Relationship is a fiduciary one based on mutual trust o Such trust requires that the partners in the relationship relate to each other in a truthful manner - Patients are expected to disclose all relevant information fully and frankly—practitioners are expected to be truthful in return 4. Truthfulness and the Practitioner-Patient knowledge Gap - The information in which health professionals trade is too difficult for lay people to understand - Health professionals are sometimes unable to tell patients the truth w/ regard to their exact condition or prognoses because they themselves do not know this o Practitioners may be uncertain about the meaning and implications of the information available to them and reluctant to communicate information that may be misinterpreted or lead the patient to jump to unwarranted conclusions - The fact that there is a gap of knowledge btw them so not be the reason why the patient is not receive the truth Truth, Truthfulness and Untruthfulness - What is truth? o Weir points out that in medical literature the nature of the truth is often taken to be “self-evident” or unproblematic - The truth is a fact telling or not telling the truth is reduced to being “accurate” or “unaccurate” in presenting patients with information about their medical condition - To be truthful is to communicate with the intent that, on the basis of our communication, the listener will understand what we ourselves know or believe to be true about the matter of concern - To be untruthful on the other hand is to intend as the effect of our communication that what we know or believe to be true to be concealed from the other o By withholding or omitting information we are untruthful to the extent that by remaining silent we are deliberately concealing something from the other - Factually true statement is not necessarily a Truthful statement o A statement may be accurate as judged against the facts—but deceptive, as when a practitioner speak in jargon knowing that the patient will not understand what is being said - The truth in empirical or Factual sense and Moral sense Chapter: 5-Truthfulness 3 o Truthfulness is not so much a matter of accuracy as it is of honesty  Did you “Intend your statement to mislead” to your patient - The moral status of practices such as withholding information equivocating, being ambiguous, communicating mixed signals, misleading and outright lying can be ascertained only if we go beyond the factual accuracy of what is said to consider the communicative context in which it is said! - Even without saying anything inaccurate our statement (and silences) can have the deliberate effect of creating or confirming a false belief, allowing a false belief to go uncorrected or otherwise keeping the truth concealed - “Truthful lie” o Health professionals superficially fulfill the duty to tell the truth by using medical jargon, knowing that the patient will be unable to decipher from what is said the truth the practitioner knows - Disclosure is influenced by their intention, the nature of their role, the relationship with their patients and the institutional culture Dialogue and Beneficent Truth-Telling - The effect of the communication will he that the patient will not learn the truth - Even if the truth is presented honestly and accurately, communication may still fall short of an important goal insofar as information is presented in a manner that is not understandable or relevant to the patient - In order to ensure that the patient understands, practitioners need not only good intention and a reliable knowledge base but also a good clinical skills in understanding and communicating with patients as the unique individual that they are - Truth-telling is not a single event but a process, or part of an ongoing dialogue o The objective of such dialogue is not simply to impart information to patients but to help them to understand over time what the truth means to them in their particular circumstances - Nurses are expected to provide persons in their care with the information they need to make informed decision related to their health and well-being. - Ongoing dialogue with patient’s provide practitioners with an understanding of their wants, needs and capabilities in light of which information can be communicated not only truthfully, accurately and understandably and also in accordance with concern for the patient’s good Truthfulness and the Predicament of Nursing - In nursing, truth-telling presents particular challenges because the role of nurses in the health care system, often place them between the physician and the patient - While the nurse and the physician alike may possess or have much of this information is primarily the prerogative of the physician Chapter: 5-Truthfulness 4 - Many nurses are institutionally bound by a “no-new information” policy, according to which they are not permitted to provide medical information that has not already been given to the patients by physicians and that practice continues today o The nurse’s ability to act in accordance with the duty to be truthful is limited o The nurse may feel obliged to communicate certain information to the patient, yet be forbidden to do so or able to do so only at the price of conflict with the physician o Nurses are likely to be better at communicating with patients than physician are  Base on that fact that they have special training in patient and family education o Nurses are more close in contact with patients makes it possible for them to establish the kind of “ongoing dialogue” that rightly emphasizes is so important for communicating the truth Case Studies: Case 1: Deciding When to Disclose a Diagnosis Story line: Barry, 17yrs-brought to the ER by friend-had ingest cocaine and marijuana-presents w/ disorganized speech and some disorientations. Is stating that people are “out to get” him-He has a persists paranoia –he as paranoid schizophrenia—Berry states if he has schizophrenia like his aunt and sister “he will kill himself” Nurses: Are having difficulty deciding if they should tell him about his diagnosis d/t to his threats of suicide Commentary - The staff need to decide how much information to disclose and in considering this question recognize that they are caught btw truthfulness and beneficence - How can they best address the conflict btw these two ethical principles?! o Option # 1:  Nurse could be vague and disclose very little in response to Barry’s queries o All members of the team will need to be sure to give the same
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