Lies To The Sick and Dying

Lies To The Sick and DyingBy: Collin Vause&Margaret Gilligan

IntroductionDeception as a TherapyLying as Result of Doctors UncertaintyDilemmas with Doctors UncertaintyDoctors Perspective vs. Patients Perspective3 Major Arguments Lying is Good Reasons Against the Arguments Respectful and Truthfulness

Deception as a TherapyDoctors are confronted with daily problems that need immediate decisions when it comes to sick and dying patients: what to reveal, what to hold back, or what to distort, will matter profoundly to patientsUsed as a therapeutic regimentThe Freedom to Lie = become an excusable act - as long as doctors are not breaking the law, they are given the liberty of how much or how little to tell the patientLying is usually wrong, but less so when telling the truth is harmful. B. C. MeyerOurs is a profession which traditionally has been guided by a perception that transcends the virtue of uttering truth for truths sake, and that is, so far as possible, do no harm.- Meyer

Telling the truth is a crucial for all doctors to uphold, but not when it puts the health and the well-being of the patient in jeopardy.Deception as a Therapy Cont.Used by doctors as a means of helping patients stay hopeful, and even stay aliveDoctors use their knowledge and expertise to make deceptive decisionsONLY doctors should use tactics of manipulating the truth, depending on each individual patients needs2 fundamental principles: doing good & not doing harm beneficence & nonmaleficence imperative for all health professionals

Deception as a Therapy Cont.All oaths, code and prayers in the history of medicine, make no mention of being truthful

The ultimate task in the medical profession: to preserve life and good health, and to ward off illness, pain, and death.From the Hippocratic Oath, in the late 5th century, to 1948 Declaration of Geneva, adopted by the World Medical Association, no mention of truthfulnessDoctors UncertaintyTo avoid misdiagnosis - different diseases and illnesses have similar symptomsUncertainty and fears revealed to the patient can reduce the patients faith in recoveryDoctors fear revealing grave risks, no matter how small, will become self-fulfilling prophecy. Hate being bearers of bad newsTime consuming takes time to explain critical illnesses or possible death situations - time is needed with other patients equally important Dilemmas with Doctors Uncertainty Doctors dont work alone other doctors and nurses are also involved in patients careDecision to lie is not universalIf one doesnt agree, he/she now has to play a part they dont think is right or humaneDifferent doctors respond differently in same situationsRelatives of sick and dying patients may disagree in how and when to tell patients Doctors Perspectivevs. Patients Perspective1) Being Truthful is impossible 2) Patients do not want to hear bad news3) Truthful information could be harmful1) Being Truthful is Impossible Where a person would typically understand what they were being told, doctors believe sick patients are often not in a position to do soNot in the right mindset to understand the truth or the gravity of the situationNot in the right mind set to make health decisions for themselves, especially if the decision needs to be made immediatelyThis gives the doctor the freedom to determine WHAT to tell the patient, and HOW to say it

ProblemsMost patients still have the ability to make correct decisions concerning their healthIf the patient does not believe they have the competence to understand the information being given, they have the right to choose a family member or close relative to receive the information for themProblem with Paternalism a person, lying to another for the good of that person this suggests that the doctor takes on a superior role over the patient, and can lead to contempt between themEven the best doctors can be wrong, and can make decisions the patients would want differently2) Patients do NOT want to hear bad newsIt means exactly what it says!Doctors say patients do not want to hear bad news, especially if that news is of a serious, frightening or depressing nature, and death is a possibilityRequires the patient to now face their illness and even soon deathSurveys have shown many doctors in this situation would NOT inform their patient of the severity of their illness, even if they had cancerIn the doctors eyes, the more a patient asks to know.the more fear he experiences.which leads to denial of ones condition, especially in the face of deathProblemsStudies show 80% of patients would like to know if their condition was life-threatening, especially something as serious as cancer15-25% of patients show signs of denial after hearing bad news, but there is no way to prove each patient experiences denialSome want to be deceived of their illness, and others go into denial and reject the bad news. Still others want to know the whole truthElizabeth Kubler-RossStudied near-death situations in patients, her 1969 book On Death and Dying, discusses 5 stages of grief: denial, anger, bargaining, depression, and acceptance. Elizabeth Kubler-Ross said denial comes from premature and abrupt information being given to a patient from a stranger

More ProblemsDoctors think they are being charitable by lyingHowever, if patients do NOT know the severity of the situation, they might agree to a surgery, blood transfusions, respirators or even resuscitations, and be simply prolonging their death unknowinglyBelieved the fear patients have in dying or being dead is due to lack of trust dying patients have in their health providersSense of trust is gone with so many strangers attending to them

3) Truthful Information Could Be Harmful Bad news could trigger suicide attempts, cardiac arrest, or prevent them from having hope of recovery Rejection of vaccinations and necessary medicationsStop fighting to live or recover

ProblemsChallenged from 2 different view points:1) Damages from knowing the truth is more rare than doctors think2) Benefits from the patient knowing the whole truth are significant What you dont know, wont hurt your slowly being proved wrong; not knowing is causing patients to worry moreNo conclusive facts to say this is the same for all patientsPhysicians still fear full knowledge will cause suicide attempts, heighten fear and depression

Suicide or Dying ResponseSuicide: could be best decision in the situationNo longer completely frowned uponOther societies allow it, and now the U.S. tooDistinctions between which suicides to respect, and which ones to preventDying Response: natural and acceptingSurrounded by friends, family, and loved onesReminiscing about lifePardoning and forgivingFinal prayers, and asking for Gods blessing on allTruthWe are still learning more and more everyday about the benefits of telling the TRUTH to patients

http://www.medscape.com/viewarticle/804885Respect and TruthfulnessNarrow, paternalistic views have been setWhat is right for one person, is not for anotherSOME patients do not understand, SOME do not want to know, and SOME can be harmed Few request to be deceivedSome give off signals they are not able to handle shock or bad news wellIn this case, concealing or withholding information from the patient is necessary, but needs to have clear and concise reasons why! Views from Laws PerspectiveThe law permits withholding of information where the truth will hurt the patient Lying for the good of the patient However, this phrase will NOT hold in a court of law too broad of a topicCan lead to doctors, nurses and other care takers to be sued

Openness, Trust & HopeGoal of doctor-patient relationship = to have a trusting and open relationship, in both personal and medical aspectTruthfulness does not mean no hopeUsing lying and deception to sick and dying patients needs to be well thought out, and all options considered for the best care of each patientOptions for PatientsInformed Consent requires all information to be disclosed to the patient, no matter how riskyLiving Wills patients specify their wishesMore and more sick and dying patients are signing living wills to include which types of information they wish to be disclosed to them

Needing Care vs. Providing CareVery important for those providing care, put themselves in the shoes of the one needing careFor doctors, putting themselves in the patients positions might make them think more about the decisions they makeFor patients, they need to respect the expertise of the doctor, and provide as much information as possible to help his/her decision makingReason why communication is so important for both the doctor and the patient, even in death and dying situationsClass ExerciseA) Answer YES or NO for the questions on the last page of your handoutB) Brief discussion of our answers

Thank you for your participation!

References Bok, Sissela.Lies To the Sick and Dying. Lying: Moral Choice in Public and Private Life (New York' Pantheon. 1978) http://www.businessballs.com/elisabeth_kubler_ross_five_stages_of_grief.htm

Caplan, A.L., PhD, Tell a Patient, Youre Terminal - - Yes or No. Medscape Business of Medicine. May 31, 2013.file:///Users/margaretgilligan/Desktop/Lies%20to%20the%20Sick%20and%20Dying/Vedio%20for%20Sick%20and%20Dying%20Pres.html http://www.bmj.com/content/346/bmj.f2560?tab=metricshttp://www.med.nyu.edu/pophealth/faculty/caplaa01