Chapter 6: Rights, Truth and Consent

Section 3. Presentation of Issues: TRUTH TELLING

 

TRUTH TELLING

Truth promotes respect for individuals and supports their autonomy.

Traditional Arguments against truth telling

Bok, Sissela. (1996). Lies to the sick and dying. In R. Munson, Intervention and Reflection: Basic Issues in Medical Ethics (5th ed.)Scarborough, Ontario: Wadsworth Publishing Company.1996, pp. 290-297). 

READ summary at: http://www.cariboo.bc.ca/ae/php/phil/mclaughl/students/phil433/bok1.htm

READ summary at: http://www.cariboo.bc.ca/ae/php/phil/mclaughl/students/phil433/bok2.htm

Three reasons for not telling the truth:

  1.  it is not possible to present the truth in a manner that he patient would understand
  2.  the patient would not want the truth, they do not want to know
  3.  the truth may harm the person, they may lose all hope if they know the truth

Counter arguments against the case for not telling the truth. Against the three reasons:

  • vs 1. It is not always true, it might depend on how the information is presented.
  • vs 2. Facts don't support this claim. Studies indicate that people do want to know the truth
  • vs 3. a number of points
  • a. harm resulting may be and often is much less than the HCP estimates
  • b. estimates of possible harm are more often based on fears of the HCP than on documented behvior of the recipient of the care
  • c. the harm resulting may be justified and acceptable to the recipient but simply not accepted by the HCP
  • d. benefits from disclosure of the truth are more substantial than most HCP believe
  • e. lies violate autonomy and self
  • f. ignorance often leads to hopelessness
  • g. lies harm collegial relationships, family relationships
  • h. lies harm the HCP-recipient relationship, TRUST is needed for therapy!!

Argument for HONESTY:

  • provides respect for a person's dignity
  • provides mental ease.
  • provides an emotional handle in the struggle to accept reality, even death.
  • assists a person to maintain control.
  • recognizes Autonomy of persons and the right to Informed Consent

Physicians must act in the best interest of those they serve.

Should the physician lie or withhold information in the best interests of those being given care or treatment? Who is to decide? Based upon what reasons?

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PLACEBOS

A primary ethical issue that arises with the use of placebos is a need to balance concern for beneficence (doing good for the recipient of care ) with respect for the autonomy of the recipient of care. To evaluate the morality of using placebos, one needs to consider both of these lines of thought. On the one hand, placebos usually involve the use of deception, which, despite the goal of beneficence, runs the risk of failing to respect autonomy. On the other hand, if one sees beneficence as a primary obligation, then one may believe that the deception involved is problematic only to the extent that it is likely to create harms that outweigh benefits.

Reasons against the use of placebos:

  1. it is a deceit
  2. encourages belief in drugs
  3. deprives recipient of care of a chance to make a decision
  4. deprives recipients of care of more effective and proven therapies

Is the deception justified?

Gregory S. Loeben, PhD: The Ethics of Prescribing Placebos: A Case of the Ends Justifying the Means? Medical Crossfire 2000; VOL 2, NO 3: 76-81

READ:  http://www.medicalcrossfire.com/debate_archive/2000/March_00/Placebo.htm

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From the University of Washington School of Medicine

Questions:

  • Do patients want to know the truth about their condition?
  • How much do patients need to be told?
  • What if the truth could be harmful?
  • What if the patient's family asks me to withhold the truth from the patient?
  • When is it justified for me to withhold the truth from a patient?
  • What about patients with different specific religious or cultural beliefs?
  • Is it justifiable to deceive a patient with a placebo?

Answers: READ http://depts.washington.edu/bioethx/topics/truth.html

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Consensus Report Defends Ethics, Utility of Placebo in Clinical Trials of Mood Disorders, NeuroPsychiatry Reiews, Vol.3, No.4,May, 2002

 READ:  http://neuropsychiatryreviews.com/may02/npr_may02_placebo.html

Health officials debate ethics of placebo use

By Susan Okie / The Washington Post ,   November 25, 2000

    WASHINGTON -- Researchers, ethicists and health officials attending a conference at the National Institutes of Health this week defended the use of placebos -- inert, dummy medicines -- as an essential tool for evaluating new drugs, and said giving them to patients in a study often can be justified even when there already is a treatment that works.
   "There has been a great shift taking place about placebo use," said Sissela Bok, a philosopher and senior fellow at the Harvard Center for Population and Development Studies. "What is clear is that the ethical issues are nowhere near resolved."
   Giving placebos to study participants has ignited a fierce ethical debate, after last month's revision of a key international medical document to declare their use unethical whenever the disease being studied already has an effective treatment.
   The document, the Declaration of Helsinki, was revised to state that experimental therapies always should be tested against "best current" treatments and that placebos should be used only when no treatment exists.
   The changes were made after controversy arose over studies conducted in Africa and Asia of experimental treatments to prevent pregnant women from transmitting the AIDS virus to their infants. An effective treatment already was in routine use in industrialized countries, but was unavailable in the countries where the research took place. Some study participants were given placebos.

READ the.remainder of article at: http://detnews.com/2000/health/0011/27/health-153054.htm

Articles On-Line:

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From the University of Washington School of Medicine

Breaking Bad News

  • Robert Buckman's Six Step Protocol for Breaking Bad News
  • What if the patient starts to cry while I am talking?
  • I had a long talk with the patient yesterday, and today the nurse took me aside to say that the patient doesn't understand what's going on! What's the problem?
  • I just saw another caregiver tell something to my patient in a really insensitive way. What should I do?

READ: http://depts.washington.edu/bioethx/topics/badnws.html

Proceed to the presentation of issues section of the chapter by clicking here> return.

Copyright Philip A. Pecorino 2002. All Rights reserved.

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