Medical deception

Withholding of medical information
Lying by medical professionals

Nature

Doctors use information as part of the therapeutic regimen; it is given out in amounts, in admixtures, and according to timing believed best for patients. Accuracy, by comparison, matters far less. The patient may be told nothing at all or only part of the story, or relevant information may be couched in technical or euphemistic language, calculated to deceive. There are instances where medical researchers have withheld information about the possible effects of an experimental drug or procedure, and at least one in the USA where researchers undertaking a drug testing programme, owned shares in the biotechnology company manufacturing the drug.

Incidence

In Japan, doctors are often so revered and secretive that they do not tell a patient that he has terminal cancer. Most doctors in a number of 1970s surveys in the USA said that they would not, as a rule, inform patients that they have cancer. However, 80% of patients with potentially serious illnesses said they would want to be told of such a diagnosis. Growing numbers are now signing statement know as "living wills", in which they can specify whether or not they would want to be informed about a serious condition; also to specify conditions under which they do not want to have their lives prolonged.

Claim

Patients are generally in favour of being told the truth about their condition. Uncertainty and confusion can often be more unsettling than the truth, which is crucial to the restoration of some control over one's affairs. There also is evidence that people recover faster from surgery and tolerate pain with less medication if they understand what ails them and what can be done for them.

Honesty from health professionals matters more to patients than almost everything else that they experience when ill. Yet the requirement to be honest with patients has been left out altogether from medical oaths and codes of ethics, and is often ignored, if not actually disparaged, in the teaching of medicine. Many physicians talk about patient deception, as in the use of placebos, in a cavalier, often condescending and joking way, whereas patients often have an acute sense of injury and of loss of trust at learning that they have been duped.

The main argument against a policy of deliberate, unvariable denial of unpleasant facts is that it makes communication extremely difficult, if not impossible. Once the possibility of talking frankly with a patient has been admitted, it does not mean that this will always take place, but the who atmosphere is changes. The fact that a patient does not immediately ask does not mean that he has no questions. It is only by waiting and listening, waiting for clues from the patient, that we can gain an idea of what we should be saying and discovery they are individuals from whom we can expect intelligence, courage and individual decisions.

Counter-claim

It is meaningless to speak of telling the truth, the whole truth, and nothing but the truth to a patient. It is meaningless because it is impossible. Physicians know only too well how uncertain a diagnosis or prognosis can be. They know how hard it is to give meaningful and correct answers regarding health and illness. Medicine is a profession which traditionally has been guided by a precept that transcend the virtue of uttering truth for truth's sake: so far as possible, do no harm. You can do harm by the process that is quaintly called telling the truth. You can do harm by lying. But try to do as little harm as possible.

Medical ethics require that the doctors are concerned for the well-being of their patients, and this is not constrained by the demand for truthfulness. It is better that the patients are able to enjoy what time they have left free from anxiety and fear. In addition, revealing grave risks, no matter how unlikely it is that these will come about, may act like a self-fulfilling prophesy.

A certain amount of lying is necessary in a busy practice. Sitting down to discuss an illness truthfully and sensitively may take much-needed time away from other patients. Also, there are many patients with language problems, the uneducated and the unintelligent, who simply cannot form an informed opinion.