Amongst the ethical principles of medicine, another major one is confidentiality, or the obligation of a physician to keep a patient's health information private. It is useful in dealing with difficult issues surrounding the terminally or seriously ill and injured. The magazine's Ethicist columnist on protecting a child's medical privacy while helping them learn about their past. The general policy in modern medicine about truth-telling is that physicians have a moral duty to be completely truthful about conditions and treatments with patients. The presumption is always for truth and against lying. Keeping the patient in the dark would preclude this. Find out more about saving to your Kindle. Peterborough: Broadview, 2012 . The plainest case of deception is outright lying. But the two are not synonymous or reducible one to the other. All of this is wrapped up in the idea of informed consent, the moral obligation of physicians to fully discuss treatment options with patients, who then have the final decision about which option to pursue. } Building this good relationship between the doctor and patient helps to promote the health and treatment of patients while enhancing accountability in the medical field. In this exception, the greater good is seen as more important than individual liberty and rights to privacy. Teleology . This stems from the medical ethical principle that patients should ultimately have control over their own bodies. Informed consent is the moral obligation of a physician to make a patient fully aware of the treatment options (side effects and expected results), risks, and benefits before letting the patient make the final decision. It is only by waiting and listening that we can gain an idea of what we should be saying. One such argument claims that there is no moral responsibility to tell the truth because truth in a clinical context is impossible. Another acceptable reason to break confidentiality is if a patient has a certain communicable or infectious disease (like a sexually transmitted disease) that must be tracked for public safety. Create your account. Because to lose the trust of others is to lose one's own integrity. Over the years physicians viewed the truth as something to conceal or reveal in so far as it impacts the therapeutic welfare of the patient. They will feel secure enough to give us these clues when they wish(12). Honesty matters to patients. Download. The department of finance in a for-profit hospital and the bedside context of a patient in the same hospital are related but different. So, if the physician believes that providing the patient with complete honesty could lead to greater harm to the patient, it can be acceptable in this case to withhold this information from the patient. 2006 Spring;15(2):123-34. doi: 10.1017/s0963180106060154. Alta Bates Medical Staff Office: (510) 204-1521. So, after the patient is fully informed, they can decide which option to take. A common framework used in the analysis of medical ethics is the "four principles" approach postulated by Tom Beauchamp and James Childress in their textbook Principles of biomedical ethics. No difference would exist between communication with a competent and an incompetent doctor. Lying is deception, but there are other forms: It should be pointed out that not every instance of withholding information is a case of deception, for example if withholding information is not done with the intent to mislead or cause false belief, and in fact does not do so. JMIR Ment Health. One is when the physician believes that providing the patient with complete honesty could lead to greater harm to the patient, so as a result, some truth is withheld from the patient. Healthcare professionals sometimes use euphemisms to avoid shocking or unduly worrying patients. Withholding information or otherwise deceiving the patient would seem to at least disrespect patient autonomy and potentially harm the patient. This argument focuses on the enormous complexity of grasping and then communicating concrete medical truth in its full sense. Examples might include disclosure that would make a depressed patient actively suicidal. Now truth, in the sense of reporting known factual information, is considered a public health responsibility and more important than a patient's right to control or to individual autonomy. It pertains to the nursing Code of Ethics' "Right to Self-Determination.". Canal Youtube Universidad de Chile The idea of a moral code extends beyond the individual to include what is. This site needs JavaScript to work properly. This has long been recognized in the words of the famous admonition to tell the truth, the whole truth, and nothing but the truth., Deception can be thought of as intentionally misleading someone, or causing someone to come to a false belief. (John 8:32) When I started writing this letter last year, I was practicing medical oncology in the United States. The medical definition of confidentiality means to keep a patient's personal health information secure and private unless the patient provides consent to release the information. By the physician providing complete honesty during this stage, the patient can fully understand their treatment options and make the best choice to yield the best outcome. Truth-telling in medicine is a broad area and often encompasses several ethical issues. J Educ Health Promot. Nurses are required to have knowledge and awareness concerning professional values to provide safe and high-quality ethical care. Comments following the cases highlight the ethical principles involved and clarify the resolution of these conflicts. The importance of truth telling in the clinical context derives from taking more seriously the patient's perspective in medical ethics. The other exception is with major communicable and sexually transmitted diseases. The whole profesion is discredited. Consequently, he had to seek a different type of work. Physicians sometimes felt patients couldnt handle the truth. medical ethics; Islam; Central to discussions concerning ethics, and medical ethics in particular, must lie an appreciation of the beliefs, perspectives, and conceptual frameworks used by our patients (boxes 1 and 2).1, 2 This task has been made more complex in recent times following the large scale migration of peoples subscribing to moral and ethical paradigms other than those of Judeo . What should be disclosed to a worrisome patient? Bio-Medical Ethics 100% (1) 3. 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." A. Virtue Ethics is about an individual of good character doing the wrong thing. ), 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. Also, complete and truthful disclosure need not be brutal; appropriate sensitivity to the patients ability to digest complicated or bad news is important. Again, there are a few exceptions. Unable to load your collection due to an error, Unable to load your delegates due to an error. Similarly, a number of studies of physician attitudes reveal support for truthful disclosure. It is useful in dealing with difficult issues surrounding the terminally or seriously ill and injured. Strictly speaking, what you said was true even if right after the party you then went to another friends house and stayed until 3 A.M. A euphemism is a vague, more comfortable term used in place of a more precise but less comfortable term. Patients place a great deal of trust in their physician, and may feel that trust is misplaced if they discover or perceive lack of honesty and candor by the physician. In the end, lies in the doctor/patient relationship hurt patients, doctors, the medical profession, and the whole society which depends upon a medical system in which patients can trust a doctor's authority. This information can help the physician to administer the best treatment so that the best outcome for the patient can be achieved. Outright lies, on the other hand, rarely are excusable. For example, some patients want to maintain a positive outlook or believe in a faith-based approach to their health and well-being. Or the provider can selectively refrain from telling the patient about some possible treatment options available in order to steer the patient toward a treatment preferred by the provider. Sigmund Freud paid more attention to the subtleties of the doctor/patient relationship than almost any other physician. In twenty-first-century Anglo-American societies, truthfulness is widely acknowledged as a central professional responsibility of physicians. See this image and copyright information in PMC. In a survey of 200 Chicago physicians published by Oken in 1961, almost 90 percent of the respondents reported that they generally withheld information about a cancer diagnosis from their patients. Those lies--lies enacted over him on the eve of his death and destined to degrade this awful, solemn act to the level of their visitings, their curtains, their sturgeon for dinner--were a terrible agony for Ivan Ilych"(3). In earlier cultures it was an ideal to treat other persons as a father treats a child. Obtain consent for interventions with patients. What kind of arguments support the answers to these questions? Unauthorized use of these marks is strictly prohibited. 9 A patient can be attended by any number of professional staff members, each of whom has a professional code and some sense of responsibility for telling the truth. If genetic tests suggest that a woman age 40 has a 20% chance of cancer which increases as she ages, when should the information be disclosed? 2018 Apr 10;19(1):25. doi: 10.1186/s12910-018-0266-5. This study sets to collect and synthesize relevant ethical evidence of the current situation in mainland China, thereby providing corresponding guidance for medical practices. For a true professional, striving to become an honest person is important. This may seem simple but really it is a hard question. The truth issue here is not that of inevitably limited human cognition trying to grasp the full complexity of a particular person's disease. In these cases, it is critical that the patient give thought to the implications of abdicating their role in decision making. For example, a physician might be reluctant to disclose the diagnosis of cancer to a vulnerable patient if he judges that the truth would be harmful, unsettling and depressing. If you think about it, in a sense we withhold information constantly when we leave out irrelevant details, yet this is a harmless sense of withholding. If someone asks you where you were they do not expect a report of every step you took, just the important ones. 1. Can patients cound on truth telling in the advertisement of HMO's, insurance companies, and pharamceutical firms? In presenting this information, does the physician or other healthcare professional (acting in a healthcare context) always have an obligation to avoid all deception? Feature Flags: { Discussion Current legal norms towards . Is concern for honesty and truth telling as absent or as threatened in other professions? Should the simple facts be disclosed? Lies will be used to benefit the doctor, the hospital, the HMO, the insurance company, the doctor's specialist friends, the free market labs in which the doctor is invested, etc. In this case, the physician can reveal this information if they believe that it can prevent the harm. 24:10 The evidence uncovered by applying these principles to the COVID-19 mRNA vaccines. Our 32 pieces of ethical guidance, providing a framework for ethical decision making in a wide range of situations.