Health professionals have to reconcile the general presumption against telling lies with these other principles of medical ethics. While healthcare professionals are as concerned to tell the truth as any other group of people, there are cases where the principles of medical ethics can conflict with the presumption against lying.
The fundamental principles of medical ethics are:
- Respect for autonomy: acknowledging that patients can make decisions and giving them the information they need to make sensible and informed choices
- Doing no harm: doing the minimum harm possible to the patient
- Beneficence: balancing the risks, costs and benefits of medical action so as to produce the best result for the patient
- Justice: using limited medical resources fairly, legally and in accordance with human rights principles
Telling the truth is not an explicitly stated principle of most systems of medical ethics, but it is clearly implied by the principle of respect for autonomy - if a patient is lied to, they can't make a reasoned and informed choice, because they don't have the information they need to do so.Respect for patient autonomy is particularly important in the case of people who are terminally ill, as they are likely to be particularly vulnerable to manipulation of the truth.
So why might healthcare professionals want to lie 'for the good of patients', and what are the arguments against this sort of lying?
- Lying may be good therapy: the doctor may believe that the patient should only be given information that will help their treatment.
- Lying deprives the patient of the chance to decide whether they want the treatment - highly intrusive treatment near the end of life may prolong life, but at greatly reduced quality, and the patient, if properly informed, might decline such treatment
- The truth may harm the patient: a patient may, for example, give up hope, go into a decline or suffer a heart attack if given a depressing diagnosis and prognosis - they may even choose to kill themselves
- Such information should be given in a way that minimizes harm -- the patient should be appropriately prepared to receive the information and given proper support after being given bad news
- Surveys suggest that patients don't in general go into a severe decline or choose to kill themselves
- Respect for autonomy requires the patient to be given the chance to consider all legal courses of action, no matter how undesirable other people may think they are
- Lying deprives the patient of the opportunity to take meaningful decisions about their life, based on accurate medical information
- The patient may realise that the symptoms they experience and the way their disease progresses don't fit what they have been told. They then experience all the bad consequences of being lied to
- The patient wants to be lied to
- Surveys suggest that the majority of patients want to be told the truth, even if it's bad
- The patient won't properly understand the truth
- It's the duty of the professional to communicate the truth in a way that each particular patient can understand, and to check that they really have understood it. (Honesty and intelligibility are particularly important when obtaining patient consent for a particular treatment or procedure.)
- The patient would go into denial and resist the truth if they were told it
- Many patients don't go into denial
- The patient still has the choice to go into denial
- Denial may be an important stage of coming to terms with the inevitable; the patient should not be deprived of the chance of working through it and dealing with their life-situation
- There is no certain truth: the future course of a disease is almost always uncertain
- the professional should give the patient the range and likelihood of possible outcomes
- The doctor doesn't want to bring the patient bad news
- This seems more for the benefit of the doctor than the patient
- Telling the patient the truth may cause the patient to use up more of the healthcare professional's time than telling a lie, when this time could more beneficially be spent on other patients
- Putting proper patient support systems in place will deal with this
Obtaining informed consent
Healthcare professionals must tell the truth and make sure that the patient understands it properly when they are obtaining the patient's consent to a procedure or treatment.If the patient is not told the truth they cannot give 'informed consent' to the proposed course of action.A patient can only give informed consent if they know such things as the truth about their illness, what form the treatment will take, how it will benefit them, the probabilities of the possible outcomes, what they will experience during and after the treatment, the risks and side-effects, and the qualifications and track-record of those involved in the treatment.There is also evidence that patients do better after treatment if they have a full understanding of both the treatment and the illness, and have been allowed to take some participation and control of the course of their treatment.