Ethics of Truth Telling PDF

Ethics of Truth Telling (4)  Introduction The truth hurts, as most people say Patients normally assume their healthcare provider is telling them the truth about a diagnosis, the results of a test, or in recommending treatment options.  Historically, providers...

Ethics of Truth Telling (4)  Introduction The truth hurts, as most people say Patients normally assume their healthcare provider is telling them the truth about a diagnosis, the results of a test, or in recommending treatment options.  Historically, providers have not been as honest and revealing as patients probably assumed. Physicians sometimes felt patients couldn’t handle the truth.  Decades ago, if a patient were diagnosed with terminal cancer the physician sometimes felt it was best if the patient wasn’t told. Better to let the patient enjoy their last few months happy rather than sad and depressed.  Attitudes have changed since then, at least in the United States, but the subject of truth- telling in healthcare is still controversial. Is it morally permissible for a provider to purposely withhold information from or otherwise deceive a patient?  What is Truth? Many ethicists recommend providers never lie to patients. Their view is that providers should always tell patients the truth because that respects patient autonomy.  In the sense relevant here, a true statement is one that corresponds to reality, to the way the world really is. So a nurse telling a patient that his blood pressure is 120/70 is telling the truth if the patient’s blood pressure really is 120/70, assuming agreement about the time and context in which the statement applies.  Sometimes there are degrees of precision involved; no one charges a nurse with lying for saying “98.6” if in fact the thermometer reading would have been more accurately described as 98.59 degrees.  Uttering true statements does not guarantee lack of deception because, as explained below, it is possible to mislead or deceive someone even when telling true statements. This has long been recognized in the words of the famous admonition to “tell the truth, the whole truth, and nothing but the truth.”  What is Deception? Deception can be thought of as intentionally misleading someone, or causing someone to come to a false belief. The plainest case of deception is outright lying.  Someone can lie to you by uttering a false statement, knowing it to be a false statement, and yet representing it as true. (Uttering a false statement by mistake is not lying.)  Lying is deception, but there are other forms: Some people consider lies that don’t matter to be “white lies” or “fibbing.” So, for example, if you suddenly come across a long lost friend who really doesn’t look too good, you might still say to her that she “looks great.” Healthcare professionals probably utter their share of white lies trying to cheer patients up.  “False suggestion” occurs when a person makes true statements but leaves out crucial information so that the hearer winds up believing something false  A “euphemism” is a vague, more comfortable term used in place of a more precise but less comfortable term. Calling a tumor “some tissue” or “a growth” may mislead someone into thinking the situation is less serious than it really is. Healthcare professionals sometimes use euphemisms to avoid shocking or unduly worrying patients  Exaggeration in the form of overstatement that is not recognized as such may be considered a form of deception.  Deception can occur through intentionally withholding, hiding, covering up, or otherwise concealing the truth without making false statements.. Over the years healthcare professionals have probably engaged in many cases of deception of patients when they thought it was for the good of the patient.  It should be pointed out that not every instance of withholding information is a case of deception, for example if withholding information is not done with the intent to mislead or cause false belief, and in fact does not do so.  if you think about it, in a sense we withhold information constantly when we leave out irrelevant details, yet this is a harmless sense of “withholding.” If someone asks you where you were they do not expect a report of every step you took, just the important ones  Moral Obligation to Tell the Truth Commonsense morality recognizes a moral obligation each of us has to tell the truth. The justification given for this may be that it is a basic moral principle, rule, or value.  Some ethicists call for basic principles or values of lucidity, veracity, and honesty. Another line of reasoning is more “utilitarian”: truth-telling just works out best for everyone in the end (“honesty is the best policy”).  Lying creates the need for more lies to cover one’s tracks, and the whole process winds up being a chain of falsehoods that eventually spirals out of control. As Mark Twain remarked, if you always tell the truth you don’t have to remember anything.  Deception in Health Care When a physician recommends a patient undergo a procedure or other medical intervention, it is commonly held the physician has a legal and moral obligation to explain the nature of the procedure, along with the anticipated benefits and possible risks, etc. in order to obtain informed consent from the patient.  Ordinarily physicians and other providers are considered to be bound by obligations to the patient of respect for patient autonomy, acting for the benefit of the patient, and refraining from anything that would harm the patient