Chapter 6: Rights, Truth and Consent

Section 4. Readings: Berkich Truth Telling

Cases Involving Truth Telling

by  Don Berkich,  University of Texas, Corpus Christi (by permission)

  1. For over twenty years, Dr. Frank has had Mr. and Ms. Caldwell as his patients. He has gotten to know them very well and considers them friends. Mr. Caldwell, who is a heavy smoker, comes by to have his yearly physical two days before he and his wife are scheduled to leave on a one-week vacation to London. They have looked forward very much to the trip; it will be for them a second honeymoon. As Dr. Frank examines the X-ray of Mr. Caldwell's chest, he discovers findings compatible with cancer of the lung. In his judgment, it would not hurt to wait another ten days before trying to evaluate the issue further. Besides, in the meantime he can show the X-ray to a radiologist for a second opinion. He decides to take two other X-rays, reassure Mr. Caldwell that nothing is wrong, and contact him when he returns from vacation.

  2. Ethel Evans, 24, has developed end-stage renal disease. Her family wants to help her acquire a transplant. Mr. and Ms. Evans and their other two children, ages 23 and 21, agree to be evaluated as possible donors. Dr. Jones, while evaluating their compatibility, discovers that neither Ethel nor her brother, who is the youngest child, could have been the child of Mr. Evans. Should Dr. Jones reveal this information to anyone? Should he instead simply state, as he has indeed found, that no one except the mother is likely to be a good donor candidate.

  3. Mr. Baker is a 57-year-old electrician who has been suffering from congestive heart failure for the last five years. He has told his physician that when it gets toward the end, he does not want to be informed of the fact that he is about to die. He just wants to be kept comfortable. In fact, Mr. Baker would like his physician to make treatment decisions without consulting him and not to tell him about unpleasant truths. As Mr. Baker puts it, "It is bad enough to live with this problem without having the damn truth rubbed in my face all the time!" Should the physician go along with Mr. Baker's request?

  4. Alice, 6, has been diagnosed as suffering from acute lyphocytic leukemia. It is explained to her parents that she has at least a 90% chance of achieving remission and that the chances of a long-term cure are greater than 50%. The parents ask the physician what they should tell Alice. They would rather not inform the child either of the diagnosis or of the prognosis. Later, one will know whether the treatment is likely to be successful and Alice will be better able to understand what is at stake. The physician agrees. But one of the nurses in the pediatric oncology unit disagrees. She argues that Alice is an intelligent child and will quickly determine the nature and seriousness of the disease. Children, she argues, share a great deal of information among themselves on an oncology ward. Who is right?

  5. "You realize that I talked to him for only fifteen or twenty minutes," said Dr. Susan Beck.

    "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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Copyright Philip A. Pecorino 2002. All Rights reserved.

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