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Ethical challenges: truth-telling and confidentiality During the process of patient and doctor relationship there are many questions and problems, which can and should be solved not from the subjective or suitable point of view, but compulsory from the point of professional ethics. The problems of confidentiality and truth-telling in medicine are of those dilemmas which require an ethical approach to be applied. In one of numerous episodes of ER, nurse Carol Hathaway promises two young patients who are reluctant to enter into care that no matter what they tell her, she will not divulge any information to the patients parents or to anyone else. Unfortunately, when it turns out that one patient has a severe medical problem, Hathaway faces the dilemma of breaking her promise of confidentiality in order to ensure proper medical care and support for her young patient. Should she break the promise she made to this young girl in order to ensure that she receives the best care possible and the support necessary in fighting her cancer?
Should she inform the school in order to bring attention to the dangerous behavior of the students? Or is it more important to maintain the clinician / patient confidentiality that is a central part of our health care system. Thus, this dilemma raises issues about the nature of confidentiality in health care, and the possible reasons why confidentiality may be broken. Confidentiality is a very old concept, reaching back even to the Hippocratic oath. There are several arguments for the need to maintain confidentiality in medicine: 1) If confidentiality is breached, patients may be reluctant to disclose full information to physicians, or may even avoid seeking care. In order for medicine to be practiced and for therapy to be effective, patients must trust in the confidential nature of the information revealed during an examination. 2) Respect for the individual patient should lead to respect for confidentiality.
Breaches of confidentiality are disrespectful of individual privacy and autonomy rights. 3) Fidelity of the physician-patient relationship requires respect for confidentiality. When patients enter into a relationship with a medical professional, an implied promise of confidentiality is made. The physician has an obligation to live up to the patient's expectations of privacy and to earn the patient's trust. While each of these arguments make a strong case for maintaining confidentiality, there are cases where confidentiality may be broken, and in fact there are circumstances where a physician has an obligation to break confidentiality. There are laws in the United States which require physicians to report certain infectious diseases to public health authorities, in order to protect the health of the community. Similar laws hold true when physicians suspect child abuse in a minor patient.
The landmark case that explores the obligation of physicians to break confidentiality is Tarasoff v. Regents of the University of California (Tarasoff vs Regents, pp. 334 - 61). In Tarasoff, a psychologist failed to warn a woman or her family when his patient threatened to murder the woman. The court in Tarasoff found that in spite of the need to protect confidentiality, especially in therapeutic settings, that the therapist had an obligation to warn the potential victim of violence.
One standard set forth in Tarasoff is that physicians have a duty to breach confidentiality in cases where harm to the patient or harm to the community may result from maintaining confidentiality. There are many reasons why confidentiality policies are to be followed in health care, and the circumstances under which confidentiality may and may not be broken should be accurately considered. However, risks to the health and life of the patient must be central in making the decision to break such a valuable trust. Another important issue which is similar to the problem of confidentiality in terms of ethical dimensions in doctor and patient relationship is a problem of truth-telling. In the practice of medicine, truth telling involves the provision of information not simply to enable patients to make informed choices about health care and other aspects of their lives but also to inform them about their situation.
Patients may have an interest in medical information regardless of whether that information is required to make a decision about medical treatment. Truth telling requires accuracy and honesty: as Cabot wrote at the turn of the century, physicians should strive to create a true impression in the mind of the patient (Cabot, 344). Thus, truth telling requires that information be presented in such a way that it can be understood and applied. The covenant of trust between physician and patient is central to the practice of medicine The candid disclosure and discussion of information not only helps patients to understand and deal with what is happening to them but also fosters and helps to maintain trust. Patients should be told the truth because of the respect due to them as persons. Patients have a right to be told important information that physicians have about them.
Not telling the truth can harm patients in many ways. Patients who remain uninformed about their condition may fail to obtain medical attention when they should. They may also make decisions affecting their lives that they would not make if they were aware of their condition. In addition, telling patients their diagnosis early in the course of a serious illness such as multiple sclerosis can be helpful simply because some people find comfort in the knowledge that physicians can name their problem. (Martin R. , 792). Not telling patients the truth about their condition may entail deceiving them. Lack of candour or outright deception, even when well intentioned, can undermine the public's confidence in the medical profession (Bok S. , 28).
In a landmark study conducted in 1961, 90 % of a sample of 219 US physicians reported that they would not disclose a diagnosis of cancer to a patient (Open D. , 1120). Of 264 physicians surveyed almost 20 years later, 97 % stated that they would disclose a diagnosis of cancer (Novack D. , 897 900). This indicates a complete reversal of professional attitudes toward truth telling, at least in the context of a diagnosis of cancer. Cultural values appear to influence physicians attitudes toward truth telling.
In one study, US physicians who reported that they commonly tell cancer patients the truth said that they did so in a way that was intended to preserve hope and the will to live, both valued notions in US society (Good M. , 59). The literature suggests that most patients want to be informed about their situation. For example, in a 1957 study involving 560 cancer patients and their families 87 % of respondents felt that patients should be told the truth about their illness (Samp R. , 382). In a study done before any treatment existed for multiple sclerosis, many patients with the disease felt they had a right to know what was wrong with them. Some were angry about being asked why they wished to know. One wrote: Do I have to explain why?
Just so that I know. (Elian M. , 27 - 28) Truth telling can be difficult in practice because of medical uncertainty and the concern that bad news might harm the patient. It can also be difficult when medical error occurs and when the patients family is opposed to truth telling. The pervasive uncertainty in medicine can and should be shared with patients. Telling patients about the clinical uncertainties and the range of options available to them allows them to appreciate the complexities of medicine, to ask questions, to make informed, realistic decisions and to assume responsibility for those decisions.
Works cited: Tarasoff v Regents of the University of California, 551 Pacific Reports, 2 nd Series (1976) Cabot RC. The use of truth and falsehood in medicine: an experimental study. Am Med 1903, rep. 1983 Bok S. Lying: moral choice in public and private life. New York: Vintage Books, 1979 Martin R. Some ethical issues in disclosure of progressive diseases of the nervous system.
South Med J 1978; Open D. What to tell cancer patients: a study of medical attitudes. JAMA 1961 Novack D, Plumer R, Smith R, Och till H, Morrow G, Bennett J. Changes in physicians' attitudes toward telling the cancer patient.
JAMA 1979 Good M, Good B, Schaffer C, Lind S. American oncology and the discourse on hope. Cult Med Psychiatry 1990 Samp R, Current A. Questionnaire survey on public cancer education obtained from cancer patients and their families. Cancer 1957 Elian M, Dean G. To tell or not to tell the diagnosis of multiple sclerosis.
Lancet 1985
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Research essay sample on Ethical Challenges Truth Telling And Confidentiality
