Bioethics in Practice: May Physicians Lie to Patients?
As a kid, my father constantly spoke to me about the power of truth. He stressed that throughout life, I, along with all my peers, would be challenged in our goal to lead lives of truth, regardless of whatever field or profession we would all enter. His belief was that without working on and perfecting my commitment to truth, I would struggle when challenged with a daunting obstacle, such as a massive monetary gain or loss.
Yet, there are many times throughout life where we encounter situations that require us to either withhold some of the truth or even slightly deceive people. In healthcare, many doctors and other health care professionals are constantly faced with difficult situations where they need to decide whether to withhold information from — or even possibly deceive — patients. These situations are subject to much debate among medical ethicists.
Fundamentally, truth has always been viewed and treated as the best policy for doctor-patient interactions. A normal patient has the autonomous power to make each decision regarding their preferred treatment, and it would only be fair for the patient to be able to choose what to do when offered the truth from the health professional. This policy is even required by The American Medical Association, which states that: “A physician shall . . . be honest in all professional interactions and strive to report physicians . . . engaging in fraud or deception, to appropriate entities.” Yet, there are many medical ethicists who argue that there are times when physicians and other health professionals need to use their discretion to sometimes withhold information or even lie to the patient as a means of saving the patient from serious harm and pain.
Professor Daniel K. Sokol, a famous medical ethicist, is a champion of this belief. He believes that in rare instances, it is beneficial for the physician to withhold information from the patient. He created a “deception flowchart,” which lays out his requisite rules for when he believes that a health professional, specifically a doctor, should deceive a patient. His flowchart leads a physician to lie to the patient when the patient is saved from psychological pain, while also possibly preserving life or giving the patient long-term autonomy. He argues that in these rare cases, the compassion of the doctor should overrule the strict code of honesty that each physician is required to uphold. As part of his flowchart, he also adds many “safety checks,” to keep the physician’s moral code balanced. In addition, he argues that the physician needs to feel comfortable defending his or her decision in a court of law and explain how this specific action would not erode the patient-physician relationship. However, he acknowledges that the most difficult factor in a physician’s decision process is time, as frequently the physician does not have time to consult a flowchart before deciding what to tell the patient.
Yet, many other ethicists argue that truth must always be upheld. They view truth as one of the core pillars that the health field relies upon to properly function. They argue that patients are privileged to make informed decisions and that they would be unable to do so if doctors were to breach the patient’s trust, even in a situation where the doctor feels that it is morally correct to do so. In addition, even if the physician was justified in lying, these ethicists believe that the patient-physician relationship would deteriorate too much and that no single situation should cause such harm to the relationship that is at the core of all healthcare.
However, while medical ethicists argue whether truth should be withheld from normal patients, many ethicists agree that when dealing with patients with cognitive defects, physicians can lie or withhold information.
For whatever field we all decide to pursue, we will be tested with challenges to our moral character and code. I hope that we are ready when these tests are thrown our way.
Photo Caption: Stethoscope
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