Is honesty always the best policy in medicine?
I can think of many reasons for why it's important to be honest in medicine, but are there any situations, rare as though they may be, in which physicians can be dishonest?
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Well honestly is very important but my grandfather ( doctor ) has lied in certain cases
like when talking to a woman who had been operated to save her baby he he comforted her telling her she and the baby would be fine
unfortunately the mother died and the father refused to take the child claiming his life was over now
my my grandad had know she was going to die but did not want it upset her
like when talking to a woman who had been operated to save her baby he he comforted her telling her she and the baby would be fine
unfortunately the mother died and the father refused to take the child claiming his life was over now
my my grandad had know she was going to die but did not want it upset her
I spent ages once at school writing an essay claiming that given the medical benefit of placebos v.s. their total lack of side effects, and the fact that the patient has implicitly given their consent to treatment by seeking treatment, that it is justifiable to give a patient a placebo with a bit of a white lie so they don't know and the placebo effect is not ruined.
However I personally don't actually agree with my conclusion, I just had to do it for my essay. I think you should always be 100% honest and all attempts to justify paternalism (as I did) still fail the morality test. You basically have to have a wholly consequentialist view, which I don't think really exists in medicine. The whole "greatest happiness for the greatest number of people" is fine and seems to inform a decent chunk of NHS financing, but I think that one of the important things about being a professional and being a doctor is having the trust of people that you've got principles and integrity. Consequentialism takes no account of that and so I don't think it's actually realistic. I would never feel comfortable lying to somebody or thinking my doctor might lie to me, even if it was purportedly 'for my own good'.
However I personally don't actually agree with my conclusion, I just had to do it for my essay. I think you should always be 100% honest and all attempts to justify paternalism (as I did) still fail the morality test. You basically have to have a wholly consequentialist view, which I don't think really exists in medicine. The whole "greatest happiness for the greatest number of people" is fine and seems to inform a decent chunk of NHS financing, but I think that one of the important things about being a professional and being a doctor is having the trust of people that you've got principles and integrity. Consequentialism takes no account of that and so I don't think it's actually realistic. I would never feel comfortable lying to somebody or thinking my doctor might lie to me, even if it was purportedly 'for my own good'.
(edited 10 years ago)
This is a really really difficult area, we talked about it in an ethics session at med school and yeah it sparked a bit of debate. Always important to bare in mind that being dishonest could result in a lack of trust in the profession.
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There are very few situations in which being dishonest is the right thing for a doctor to do. I think these would probably only include those where not being dishonest will endanger your / patients' / the public's safety. "Patient safety is your primary concern" yada yada.
For example - in the right context it may be acceptable to confabulate with a patient with delirium, which might be considered slightly dishonest, if it protects their well being (perhaps this calms them / talks them down from doing something to endanger themselves?).
Or - say you are aware that a patient is a danger to the public and/or is threatening you, and they directly ask you if you intend to contact the police, and you reasonably believe that being honest will endanger yourself or someone else, I think it would be reasonable to lie.
For example - in the right context it may be acceptable to confabulate with a patient with delirium, which might be considered slightly dishonest, if it protects their well being (perhaps this calms them / talks them down from doing something to endanger themselves?).
Or - say you are aware that a patient is a danger to the public and/or is threatening you, and they directly ask you if you intend to contact the police, and you reasonably believe that being honest will endanger yourself or someone else, I think it would be reasonable to lie.
(edited 10 years ago)
Withholding information in order to maintain confidentiality is probably the commonest form of dishonesty necessary.
Placebos have side effects, occasionally more than the medication being tested! And they work even if the patient knows they're a placebo
I agree they shouldn't be used though, except in very specific circumstances. Erodes trust in the profession.
Original post by seaholme
I spent ages once at school writing an essay claiming that given the medical benefit of placebos v.s. their total lack of side effects, and the fact that the patient has implicitly given their consent to treatment by seeking treatment, that it is justifiable to give a patient a placebo with a bit of a white lie so they don't know and the placebo effect is not ruined.
Placebos have side effects, occasionally more than the medication being tested! And they work even if the patient knows they're a placebo
I agree they shouldn't be used though, except in very specific circumstances. Erodes trust in the profession.
I think I would always only make a decision when I was faced with the particular situation, right there.
To be honest, I trust my judgement. If it's not obvious to me whether to lie or not lie in a particular situation, I'd just go for one (perhaps on a whim - like going ip-dip-doo at a polling station, perhaps it'd depend on past experiences, perhaps I'd tend to avoid lying because of Christian teachings - opting to withhold details instead). Then if it turns out that was the wrong decision later on, I'd just think, 'oh well, I'm a human, I'm gonna make mistakes sometimes. The answer wasn't clear to me.'
I wonder if I'll be a ruthless doctor in the future...
I'm caring, honest.
To be honest, I trust my judgement. If it's not obvious to me whether to lie or not lie in a particular situation, I'd just go for one (perhaps on a whim - like going ip-dip-doo at a polling station, perhaps it'd depend on past experiences, perhaps I'd tend to avoid lying because of Christian teachings - opting to withhold details instead). Then if it turns out that was the wrong decision later on, I'd just think, 'oh well, I'm a human, I'm gonna make mistakes sometimes. The answer wasn't clear to me.'
I wonder if I'll be a ruthless doctor in the future...
I'm caring, honest.
My experience of "clinical lying" is that it hasn't been a case of one doctor lying to the patient on the fly. It seems to be more often that a piece of information will come to the attention of the team and there will be a discussion about what to tell the patient. E.g. What happens if the partner of a very demented patient dies while they are in? If you told them, they would forget in 10 minutes, so is it fair to break that news to a person 10 times per day when they ask when their partner is coming?
I had a friend who was dying and her Dad chose not to tell her, and continued to tell her that she was going to be okay, despite her asking him several times. I don't think this is right. If you're trying to save somebody's feelings then by all means hide the truth - but if they ask the question outright you can't then withhold the answer.
Original post by xoxAngel_Kxox
I had a friend who was dying and her Dad chose not to tell her, and continued to tell her that she was going to be okay, despite her asking him several times. I don't think this is right. If you're trying to save somebody's feelings then by all means hide the truth - but if they ask the question outright you can't then withhold the answer.
You can and should withhold the answer if the patient has capacity and they don't consent for information to be disclosed to another party. There are of course sensitive ways of doing this, but it is entirely the patients choice so long as they are able to make that choice.
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Original post by xoxAngel_Kxox
I had a friend who was dying and her Dad chose not to tell her, and continued to tell her that she was going to be okay, despite her asking him several times. I don't think this is right. If you're trying to save somebody's feelings then by all means hide the truth - but if they ask the question outright you can't then withhold the answer.
Depends on the age, but yeah i agree - i would certainly not avoid the direct question if i were the parent. If they felt the need to ask, they clearly know something is wrong, and i'm not sure hiding the truth from them helps at all.
The most emotional story i ever came across was a similar situation. 5y/o girl with a circa 4 month prognosis and the parents were withholding that from her, giving her the best time they could but ensuring they or her doctors never talked about it in front of her. Then at a birthday party a friend's parent asked whether she'd had a good time and whether she'd come next year, to which she responded 'don't be silly - i'll be dead by then'.
Even young kids can have surprising intuition.
Original post by Mushi_master
You can and should withhold the answer if the patient has capacity and they don't consent for information to be disclosed to another party. There are of course sensitive ways of doing this, but it is entirely the patients choice so long as they are able to make that choice.
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I'm saying that the prognosis was hidden from the PATIENT, not the family.
Original post by xoxAngel_Kxox
I'm saying that the prognosis was hidden from the PATIENT, not the family.
Apologies just realised my mistake, misread that somehow.
That absolutely changes things, that's a very tricky area indeed but I really do think in the vast majority of cases the patient knowing their prognosis is absolutely in their best interests, unless they have specifically asked not to be told.
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I personally think doctors should be allowed to give placebos to patients in some circumstances.
Of course this is under the discretion of the clinician but if the patient is presenting symptoms which require no treatment at all yet the patient is insistent on receiving something, I believe it is far better to give a placebo than potentially contribute to antibiotic resistance or unwarranted side effects typically associated with psychological drugs.
Studies have shown the benefit of placebo drugs; don't discount the power of the mind. This is especially true when you consider disorders of the mind.
Perhaps I'm in the minority, but IMO, it is not unethical to give a sugar pill to a patient. Besides, better than than to have an angry patient complain about your practice for no good reason at all, especially given the current system is being setup on 'patient reviews'.
Of course this is under the discretion of the clinician but if the patient is presenting symptoms which require no treatment at all yet the patient is insistent on receiving something, I believe it is far better to give a placebo than potentially contribute to antibiotic resistance or unwarranted side effects typically associated with psychological drugs.
Studies have shown the benefit of placebo drugs; don't discount the power of the mind. This is especially true when you consider disorders of the mind.
Perhaps I'm in the minority, but IMO, it is not unethical to give a sugar pill to a patient. Besides, better than than to have an angry patient complain about your practice for no good reason at all, especially given the current system is being setup on 'patient reviews'.
Original post by Padwas
Well honestly is very important but my grandfather ( doctor ) has lied in certain cases
like when talking to a woman who had been operated to save her baby he he comforted her telling her she and the baby would be fine
unfortunately the mother died and the father refused to take the child claiming his life was over now
my my grandad had know she was going to die but did not want it upset her
like when talking to a woman who had been operated to save her baby he he comforted her telling her she and the baby would be fine
unfortunately the mother died and the father refused to take the child claiming his life was over now
my my grandad had know she was going to die but did not want it upset her
Saw on TV a neurosurgeon who has told a patient everything will be OK because he did not want to scare her. She had an inoperable brain tumor. She was young girl, early 20s. He did not want to upset her. I don't believe she had long to live.
Original post by oz40
Saw on TV a neurosurgeon who has told a patient everything will be OK because he did not want to scare her. She had an inoperable brain tumor. She was young girl, early 20s. He did not want to upset her. I don't believe she had long to live.
Same in this case it was to comfort as added stress for the mother could harm childbirth
Original post by nexttime
Withholding information in order to maintain confidentiality is probably the commonest form of dishonesty necessary.
Placebos have side effects, occasionally more than the medication being tested! And they work even if the patient knows they're a placebo
I agree they shouldn't be used though, except in very specific circumstances. Erodes trust in the profession.
Placebos have side effects, occasionally more than the medication being tested! And they work even if the patient knows they're a placebo
I agree they shouldn't be used though, except in very specific circumstances. Erodes trust in the profession.
If that is the case in trials why don't they just tell the patient it is a placebo. A double blind trial is usually done I think. However, bearing in mind what you said surely it would be better to tell the patient it is a placebo as it would rule out any effect of the drug which are just due to psychological factors (i.e. the patient thinking it is working just because they are being given medication)
(edited 10 years ago)
I find myself having to lie quite often as a medical student when I might know something bad that the doctors haven't broken to the patient yet, or when a patient asks me "Is that ECG bad?" or similar - well to me it looks like a terrifyingly big heart attack but I can't say that!
Original post by Fission_Mailed
My experience of "clinical lying" is that it hasn't been a case of one doctor lying to the patient on the fly. It seems to be more often that a piece of information will come to the attention of the team and there will be a discussion about what to tell the patient. E.g. What happens if the partner of a very demented patient dies while they are in? If you told them, they would forget in 10 minutes, so is it fair to break that news to a person 10 times per day when they ask when their partner is coming?
How do you answer the question? or do you just try and move away from it and change the question or say that you're not sure when their partner is coming
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