OBLIGATION TO TELL THE TRUTH
As part of the professional contract between the physician and the patient, the physician
must tell the whole truth. Veracity is based on respect for autonomy, fidelity, and confidentiality. Patients have the right
to know the risks and benefits of medical procedure in order for them to make
an autonomous informed consent. Deception violates fidelity.
The principle of veracity is derived from
WHAT IS DISCLOSED
Disclosure of some forms of information may constitute malefacence. There is no obligation
to disclose information that the patient does not request or does not want. Some patients may prefer not to know the truth.
There is no obligation to disclose unwanted information. Patients should be told only what they need to know or what they
want to know.
PARTIAL DISCLOSURE and WHITE or TECHNICAL LIES
Partial disclosure can be considered a half truth and therefore a form of lying. Technical
lies are statements that are apparently true and whose truth can be defended using data and reasoning but they contain an
element of untruth that any person privy to the whole information will be able to discern. The physician may consider telling
‘white lies’ for the sake of the patient welfare. The physician should be guided in his communication by the background
and understanding of a patient. Some patients can be given a lot of information and they do not get disturbed. Some types
of information agitate patients. The prophet taught talking to each person according to his ability to understand.
DISCLOSURES TO OTHERS ABOUT THE PATIENT
It may be necessary that the physician shares some confidential information with members
of the family in order to get involve them in patient care. This may take the form of getting more information about the patient,
consultation about the best care or trying to interpret and understand the patient’s choices and decisions. In general
divulging unsolicited information to governmental or other authorities is frowned upon.
GIVING BAD NEWS
Bad news is common in medicine. The patient may have to be told
about a diagnostic result that indicates a more serious disease than had been anticipated. The prognosis may be bad or the
treatment may fail. In general it is better to keep quiet than to pronounce anything that is uncomfortable. However the obligation
or veracity and transparency force the physician to give bad news to the patient and the family.
Telling the patient half truths or white technical lies may be
a way out of the dilemma of giving bad news but it destroys the confidence and trust that patients put in doctors. Telling
a straight lie is forbidden. Each case should be evaluated on its own merits by balancing benefits and injuries. In the end
it may be better to be straight in dealing with the patient and warn them before giving bad news. Their permission could also
be asked. Some may prefer that they be not told the whole truth because that would distress and disturb them.
Some bad news is better given to the relatives. They can
find a way of conveying the information in a gentler way that minimizes the mental injury to the patient. They may also make
a better judgment of what to tell and what not to tell the patient.
Some bad news may be given to authorities in the form of medical certification for temporary
or permanent disability, sick leave, and return to work.
Physicians should be careful about their body language. It is very difficult to hide feelings
inside. The patient will read the body language and will believe it more than verbal language. A verbal reassurance of the
patient that he will so well can be contradicted by show of worry and agitation on the face of the physician. This is perhaps
one argument for telling the whole truth to the patient whatever the consequence because they can read it for themselves from
the physician’s body language.