Chapter 6: Rights, Truth and Consent
Section 4. Readings: Berkich Truth Telling
Cases Involving Truth Telling
by Don Berkich, University of Texas, Corpus Christi
"Yeah, but you psychiatrists are supposed to be able to size up a guy just by listening to how he says hello," Dr. Mark Brunetti said.
"Now that I've talked to him, tell me more about him," Beck said.
"I presume you learned his name is T.D. Chang?"
"That was written down for me."
"Fine," said Brunetti. "He's fifty-two years old, a professor of Asian History at Southwestern University. He's married, has two children in college, and has a solid scholarly reputation."
"What about his complaint?" asked Beck.
"About a month ago he began to experience difficult and painful urination. His attending examined him, found he had an enlarged prostate, and treated with sulfa. No joy. So the attending sent him here. We're doing an X-ray scan and a punch biopsy in the morning."
"And you want me to tell you how I think he'll take it if you suspect cancer?"
"Right," said Brunetti. "I don't like to scare people unless I have to. My inclination here is just to keep quiet until we know for sure."
"I think he would take it all right. He shows no tendency toward hysteria, and his background reveals him to be a person who functions well under normal conditions of stress."
"Good, then if I have to tell him, I won't worry about it."
"Mark, do you mean you're not going to tell him?"
"That's right. Not until I know for sure. It's a kindness to him. What he doesn't know won't hurt him, and there's no reason to cause him unnecessary anxiety."
"I don't think I agree with that decision," Beck said. "I think a man like Mr. Chang has a right to know as much about his condition as you do."
"That's silly," Brunetti said. "He can't possibly know as much as I do, and he wouldn't know what to make of the information even if I gave it to him. He would probably figure he's going to die in the next hour."
"So you aren't going to tell him what you suspect or why you're doing the biopsy?"
"I'm not that cruel, even if I am a surgeon."
F. Multiple Sclerosis is a chronic, progressive, neurological disease with symptoms that include loss of coordination, blurred vision, speech difficulties, an severe fatigue. It is most frequent among young adults. A study at Albert Einstein Medical College revealed that MS patients typically had a very hard time getting an explicit diagnosis and explanation form their physicians. Yet the physicians surveyed reported overwhelmingly that they always or usually tell patients the diagnosis.
The researchers learned that a variety of factors account for this discrepancy. Physicians find many reasons for delay--the patient may be under twenty, emotionally unstable, or apparently incapable of understanding the diagnosis. Also, the patient may not ask specifically, a relative may ask that the patient not be told, the patient may be medically unsophisticated or in the midst of an emotional crisis. Most important, there is no cure or wholly effective therapy for MS, and emotional stress seems to aggravate its symptoms. Telling a patient that she or he has a progressive, incurable disease may do no good and may do harm.
Patients are frequently told that they have "a chronic virus infection," "neuritis," and "inflammation of the nervous system," instead of being told they have MS. This sometimes leads patients to consult several physicians and to undergo expensive and unnecessary diagnostic tests in the attempt to get a diagnosis.
--cases A - D adapted by Garreth Matthews from B.A. Brody, Bioethics, Prentice-Hall, 1987, pp. 349-50; cases E and F are from Ronald Munson, Intervention and Reflection: Basic Issues in Medical Ethics, 5th ed., Wadsworth, 1996, pp. 317-18.
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