Recently I read an article in The New York Times, “Medical Misstep”. In this article, one of the healthcare professionals tells a story that happened in his hospital. A seriously ill patient was admitted to the hospital with multiple organ dysfunction. This patient was unable to make decisions for himself due to his critical condition. A blood transfusion was indicated, but the patient’s family refused because of religious reasons. One evening the on-call resident, unaware of the patient’s faith, ordered a transfusion. There were no clinical consequences. Disclosure would likely cause the family significant emotional distress. (Cohen 2006.) Healthcare professionals were facing the dilemma whether to disclose the truth to patient’s family or not. Readers were asked this very question. Their answer was to tell the truth. I agree with the readers that the truth must be told.
This article made me think beyond this particular situation. Healthcare professionals face the dilemma whether to tell the truth or beneficent deception when the medical error occurred or when the patient was diagnosed with a serious and perhaps incurable illness.
In my opinion, communications between healthcare providers and patients should be truthful. Patients must know that they can trust and believe their doctors. Healthcare professionals more than anyone else have an obligation to tell the truth and it cannot be overridden by speculation about possible harms. The physician’s duty to tell the truth is not limited to good news. By not disclosing the error the healthcare institution would jeopardize its reputation, lower the morale of the employees and perhaps face litigation. By not telling the truth about the seriousness of patient’s diagnosis, healthcare professionals would omit the patient’s right to know the truth. The patient has a need for the truth if he or she is to make rational decisions about actions and plans for life. (Jonsen 1998.)
In my opinion, when healthcare professionals make the decision not to advise the patient or family members of a medical error or a serious diagnosis, they are trying to avoid possible negative ramifications for themselves, not the patient or the family. It should not matter how difficult it may be for the patients and their families, as they have a right to know the truth. There is no medical error or illness that would not cause some emotional distress. Consequently, physicians must be very careful when they speak to their patients or the family members about the medical error or a serious diagnosis. “Speaking truthfully and relating the facts of the situation does not preclude a manner of relating the facts that is measured to perceptions of the hearer’s emotional resilience and intellectual comprehension. The truth may be “brutal”, but telling of it should not be.” (Jonsen 1998.)
Honesty is an essential part of the healthcare industry. Patients should be able to count on their healthcare providers and trust them. Trust is a key element of the foundation of the physician-patient relationship, without which the relationship is sure to deteriorate.
1.) Randy Cohen. (2006). The New York Times. The Ethicist: Medical Misstep.
2.) Jonsen A., Siegler M., Winslade W. (1998) Clinical Ethics: A Practical Approach to Ethical Decisions in Clinical Medicine, Fourth Edition. USA: McGraw Hill Companies, Inc.