Should Doctors Always
Tell Their Patients
The Full Truth?
By Bruce Hilton
From Scripps Howard News Service
Note - We received the following note from Frances along with the article below. We felt the message from Frances to be well worth including:
This practice of lying to patients and not replying to specific questions I abhor. My daughter's doctor flew into a rage at me, when she was deathly ill with pneumonia and in an oxygen tent (she almost died that night) when I told her to hang on and fight it because if she didn't she was going to die. I said it with sincerity and gravity, because I KNEW if she didn't know how severe her situation was and left it up to the doctors and not her will (she's as strong willed and headed as I am) she wouldn't live to see the daylight of the following morning.
I knew that from my own experience when I had the Scalded Skin Syndrome and only realized I was going to die, and that they didn't expect me to live longer than 24 hours, when they put me in the NICEST ROOM on the floor. I knew that from my nursing days. We were told that all terminally ill patients that weren't expected to survive longer than 24-48 hours were to be given the nicest surroundings possible with the nicest rooms and even fresh flowers to cheer the room up during the daytime, even if no friends or family supplied any. When they wheeled my bed into that room, I KNEW if I didn't will myself to live I was going to die without ever having even held my daughter, Stephanie.
So I think this is a really IMPORTANT issue. No one wants to die and if they KNOW they are in grave danger of dying they will use every ounce of their soul and/or will to get better. Doctors allow people to wallow in the ignorance that they are taking care of them and making them better, when in reality our wills and souls have more to do with that than they do. The practice of physicians lying to their patients HAS TO STOP.
Sincerely, Frances
Must physicians always tell the truth, the whole truth, and nothing but the truth? Or are there times when a little white lie is actually in the patient's interest?
The question comes up again because of the beating the truth seems to be taking elsewhere.
Cover-ups, character attacks and the swoosh of hot air from political spins make us wonder what the truth is. And worse, to ask whether it really matters any more.
Well, one person to whom it matters is Harvard professor Sissela Bok.
She's one of the world's true experts on equivocation, a professor of prevarication, if you will.
Her book on the subject brought high praise when it was published 20 years ago and is still selling well in paperback. In keeping with her no-nonsense approach, the book is simply called, "Lying."
A teacher of ethics at the Harvard Medical School, Bok got into the subject of while doing research for a medical journal article on placebos -- the sugar pills doctors sometimes give patients for their psychological effect.
Soon she had run into numerous other situations involving white lies and white coats.
----Should a physician lie to dying patients so as to delay the fear and anxiety which the truth might bring them?
----Or should a doctor lie to a patient to avoid worry that might delay his or her recovery?
Bok found a widely known Catholic medical textbook that advised doctors and nurses to lie "by mental reservation" when they thought it was wise to do so.
She writes: "If a feverish patient, for example, asks what his temperature is, the doctor is advised to answer, 'Your temperature is normal today,' while making the mental reservation that it is normal for someone in the patient's precise physical condition."
----A physician was asked by a longtime patient to certify that "medical reasons" made it unwise to bus her 7-year-old boy into another neighborhood as part of a court-ordered racial integration program.
----Or family members whose "spare" kidney is a life-saving match for a patient sometimes agree to be a donor while hiding deep anxieties and a strong desire not to donate.
Physicians who recognize such a situation will sometimes honor the unwilling donor's unexpressed wishes by reporting falsely that he or she was not a good tissue match.
There are other dilemmas not mentioned in the early editions of "Lying."
For example, genetic tests for newborn babies, developed in the last decade, can reveal that the husband is not the baby's father. Must the doctor tell?
And in Oregon the new law allowing physician-assisted suicide (PAS) has created truth-telling dilemmas. Doctors are not required to participate in PAS if it violates their conscience, but are required, as in all medical procedures, to refer the patient to another physician. But they are not required by law to tell the patient about PAS while discussing end-of-life care. Do they have a moral duty to tell, when not telling limits the choices of the patient?
Bok made two daunting discoveries while researching her book.
----"The requirement to be honest with patients has been left out altogether from medical oaths and codes of ethics, and is often ignored, if not actually disparaged, in the teaching of medicine. Doctors want the option of lying left open, Bok found, because of "a severely restricted and narrowed paternalistic view -- that some patients cannot understand, some do not want, and some may be harmed by knowledge of their condition."
----"Many physicians talk about such deception in a cavalier, often condescending and joking way, whereas patients often have an acute sense of injury and of loss of trust at learning that they have been duped."
This is an outgrowth of the old paternalistic model of medical practice, in which the doctor is the lord of the castle, up on the hill, and the patient is the village idiot down in the flatlands.
Both these situations have changed since "Lying" was first published. Many medical schools now have ethics courses, and truth-telling is stressed. Most physicians consider truth-telling an important ideal -- though many still find rationalization for the "therapeutic lie."
The burden of proof has to fall increasingly on the physician who wants to bend the truth; it can't any longer be done casually or condescendingly. Bok offers three reasons for telling patients the truth:
----The medical and psychological benefits to them from this knowledge.
----The unnecessary and sometimes harmful treatment to which they can be subjected if ignorant.
----The harm to physicians, their profession and other patients as a result of the lie.
BRUCE HILTON, director of the National Center for Bioethics, has been an ethics consultant to doctors, hospitals and patients since 1972. He can be reached at