Historically, providers have not been as honest and revealing as patients probably assumed. But truthfulness does not. (1) They also have obligations created by institutional policies, contractual arrangements, and their own family commitments. Now, more than ever, patients have to be able to trust their doctors and to be able to rely on the truth of what they are told. Without honesty and trust, human beings are condemned to an alienating isolation. To live without confronting the inevitability of death is not to live in anything approaching a rational or moral way. An additional and newer influence on medical ethics is the human rights movement. Get Email Alerts Below, find the 10 most popular AMA Journal of Ethics articles published this year. Virtue ethics looks at virtue or moral character. (Reprinted in Medical Ethics, 2 nd ed. eCollection 2022. In this exception, the greater good is seen as more important than individual liberty and rights to privacy. This perspective is a good start, but unfortunately refraining from lying is not the whole story on truth and deception. The standard of professional candor with patients has undergone a significant change over the past 30 years. Family members rather than the patient are given medical information, especially threatening information like a fatal diagnosis. It is a multidisciplinary lens through which to view complex issues and make recommendations regarding a course of action. 1961. It is even worse to adopt a pattern of deception. However, there are a few situations when truth-telling isn't always plausible. A virtue ethics perspective Truth-telling is a key issue within the nurse-patient relationship. If a genetic test indicates that a certain disease at some point will be expressed, for which there is no cure or therapy, should the eventual disease manifestation simply be disclosed? Why? A provider can lie to a patient about the nature of a diagnosis or the risky nature of a procedure. Radical advocates of patient autonomy tend to eliminate physician or nurse discretion and simply require that "everything be revealed" because "only the patient can determine what is appropriate." Contact the MU School of Medicine. Doctors and nurses in some cultures believe that it is not wrong to lie about a bad diagnosis or prognosis. In a clinical setting, telling the truth has to do with a particular patient, who has a particular illness, and a particular history. In the medical field, truth-telling involves the moral obligation of the health care provider to tell the patient the truth about their medical condition and diagnosis while balancing the imperative and moral obligation of ''to do no harm'' to the patient. As discussed in the previous section, physicians have a moral obligation to do no harm to the patient. Truth-telling in medicine is a broad area and often encompasses several ethical issues. Sometimes patients request that information be withheld. ), The use of truth and falsehood in medicine: an experimental study, Offering truth: one ethical approach to the uninformed cancer patient, Physicians attitudes toward using deception to resolve difficult ethical problems, Find out more about saving to your Kindle, Chapter DOI: https://doi.org/10.1017/CBO9781139058575.010. This article is intended to be a brief introduction to the use of ethical principles in health care ethics. This is why the issues of truth-telling, informed consent, and confidentiality are essential to the success of any relationship between a patient and a health care professional. Not only is patient autonomy undermined but patients who are not told the truth about an intervention experience a loss of that all important trust which is required for healing. Download. In addition to fostering trust and demonstrating respect, giving patients truthful information helps them to become informed participants in important health care decision. Maybe they want a family member to make medical decisions, for cultural or personal reasons. The importance of truth telling in the clinical context derives from taking more seriously the patient's perspective in medical ethics. Beauchef | @free.kindle.com emails are free but can only be saved to your device when it is connected to wi-fi. What should be disclosed to a worrisome patient? Respecting patient autonomy means allowing patients to make their own decisions about whether to have certain tests, procedures, treatments, or other interventions recommended by the healthcare provider. Generally, physicians are expected to be fully truthful about conditions and treatments, but there are exceptions if full honesty could lead the patient to greater harm or if the patient states a preference to not know the truth. Doctors and nurses, however, can do as much harm by cold and crude truth-telling as they can by cold and cruel withholding of the truth. Copyright 2023 Curators of the University of Missouri. But clinical judgement is always required because in some cases, even a reluctant and intimidated patient who requests not to be informed, needs to know some truths. A doctor can do even greater harm because not being honest damages the climate of trust within the profession. Circumstance, intention, and consequences may mitigate its gravity but could never change the inherent evil of untruthful speech. The image of the legal profession portrayed in this film was sickening. Truth telling has to be linked with beneficence and justice and protection of the community. Truth-telling or honesty is seen as a basic moral principle, rule, or value. 20:46 On the benefits of a rigorous peer-review process. Such tenets may allow doctors, care providers, and families . Were Augustine and Kant right when they admitted of no exceptions to the duty to tell the truth, or were the Confessor and Casuists right when they insisted on considering consequences, intention and circumstances, and when they considered some lies to be of little or no moral import? As described in Chapter 3, the principle of nonmaleficence has its origins in the ancient medical pledge to "do no harm," and is best understood today as a commitment to refrain from actions that are likely to cause more harm than benefit. Find out more about saving content to Google Drive. Confidentiality is a second ethical principle. Ethics in Health Care Explore the AMA Journal of Ethics for articles, podcasts and polls that focus on ethical issues that affect physicans, physicians-in-training and their patients. The doctor's principal moral obligation was to help and not to harm the patient and consequently, whatever the doctor said to the patient was judged by its effect on these core duties. 550 lessons. The reason for this is that if the confidentiality of information were unprotected, patients may be less likely to share sensitive information, and not sharing sensitive information could have a negative impact on patient care. Learn about the ethical values in medicine. This article . The principles are beneficence, non-maleficence, autonomy, justice; truth-telling and promise-keeping. Honesty is still preferred, but there are two situations where it is considered acceptable to not be completely truthful. Rather, it is the question of what to disclose of known information in order to make sure that the disclosure helps the patient or in order to keep the truth which is known from doing a vulnerable patient more harm than good. Again, there are a few exceptions. Its like a teacher waved a magic wand and did the work for me. J Adv Nurs. Even in Kant, an assumption exists that lying violates an objective moral standard. hasContentIssue false, Ethics in health care: role, history, and methods, Moral foundations of the therapeutic relationship, Professionalism: responsibilities and privileges, Controversies in health care ethics: treatment choices at the beginning and at the end of life, Ethics in special contexts: biomedical research, genetics, and organ transplantation, Part II - Moral foundations of the therapeutic relationship, Twenty-two-year-old Annie was brought by friends to the ED of a small Virginia hospital. Truth obviously is an essential moral good. Avoiding intentional deception by whatever means? Teleology . The second circumstance is if the patient states an informed preference not to be told the truth. To save content items to your account, An overview of ethics and clinical ethics is presented in this review. (..)So much of the communication will be without words or given indirectly. We may recognize and readily admit epistomological complexity as well as an inevitable human failure to achieve "the whole truth". It may be an exaggeration to say that honesty is neither taught in medical school nor valued in medical culture, but it is not too much of an exaggeration. For instance, some patients might ask that the physician instead consult family members. Questions about truth and untruth in fact pervade all human communication. In these cases, physicians have a duty to report this information so public health officials can track and prevent the spread of disease. An autonomous patient is not only entitled to know (disclosure) of his/her diagnosis and prognosis, but also has the option of forgoing this disclosure. 2007 Jun;33(6):337-41. doi: 10.1136/jme.2006.017806. Certainly this is a difficult truth to tell but on balance, there are many benefits to telling the truth and many reasons not to tell a lie. After what kind of broader patient assessment? This argument, understood in abstraction, is respectable, and yet in its application it turns out to be fallacious. In twenty-first-century Anglo-American societies, truthfulness is widely acknowledged as a central professional responsibility of physicians. Relational, contextual, clinical truth always points toward the incorporation or application of what is objective and abstract. TYPES OF ETHICS Medical Ethics: Clinical obligations fidelity first to patients' interests telling the truth (cancer, errors) Professional Ethics: Obligations of the profession self-regulation education of self and others Bioethics: Guides for public policy gene technology, stem cell research health system . Truth telling is even more obviously necessary in order to sustain human relations. 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