- Note - We received the following note
from Frances along with the article below. We felt the message from Frances
to be well worth including:
- This practice of lying to patients and
not replying to specific questions I abhor. My daughter's doctor flew into
a rage at me, when she was deathly ill with pneumonia and in an oxygen
tent (she almost died that night) when I told her to hang on and fight
it because if she didn't she was going to die. I said it with sincerity
and gravity, because I KNEW if she didn't know how severe her situation
was and left it up to the doctors and not her will (she's as strong willed
and headed as I am) she wouldn't live to see the daylight of the following
- I knew that from my own experience when
I had the Scalded Skin Syndrome and only realized I was going to die, and
that they didn't expect me to live longer than 24 hours, when they put
me in the NICEST ROOM on the floor. I knew that from my nursing days. We
were told that all terminally ill patients that weren't expected to survive
longer than 24-48 hours were to be given the nicest surroundings possible
with the nicest rooms and even fresh flowers to cheer the room up during
the daytime, even if no friends or family supplied any. When they wheeled
my bed into that room, I KNEW if I didn't will myself to live I was going
to die without ever having even held my daughter, Stephanie.
- So I think this is a really IMPORTANT
issue. No one wants to die and if they KNOW they are in grave danger of
dying they will use every ounce of their soul and/or will to get better.
Doctors allow people to wallow in the ignorance that they are taking care
of them and making them better, when in reality our wills and souls have
more to do with that than they do. The practice of physicians lying to
their patients HAS TO STOP.
- Sincerely, Frances http://www.onelist.com/subscribe.cgi/FF1
- Must physicians always tell the truth,
the whole truth, and nothing but the truth? Or are there times when a little
white lie is actually in the patient's interest?
- The question comes up again because of
the beating the truth seems to be taking elsewhere.
- Cover-ups, character attacks and the
swoosh of hot air from political spins make us wonder what the truth is.
And worse, to ask whether it really matters any more.
- Well, one person to whom it matters is
Harvard professor Sissela Bok.
- She's one of the world's true experts
on equivocation, a professor of prevarication, if you will.
- Her book on the subject brought high
praise when it was published 20 years ago and is still selling well in
paperback. In keeping with her no-nonsense approach, the book is simply
- A teacher of ethics at the Harvard Medical
School, Bok got into the subject of while doing research for a medical
journal article on placebos -- the sugar pills doctors sometimes give patients
for their psychological effect.
- Soon she had run into numerous other
situations involving white lies and white coats.
- ----Should a physician lie to dying patients
so as to delay the fear and anxiety which the truth might bring them?
- ----Or should a doctor lie to a patient
to avoid worry that might delay his or her recovery?
- Bok found a widely known Catholic medical
textbook that advised doctors and nurses to lie "by mental reservation"
when they thought it was wise to do so.
- She writes: "If a feverish patient,
for example, asks what his temperature is, the doctor is advised to answer,
'Your temperature is normal today,' while making the mental reservation
that it is normal for someone in the patient's precise physical condition."
- ----A physician was asked by a longtime
patient to certify that "medical reasons" made it unwise to bus
her 7-year-old boy into another neighborhood as part of a court-ordered
racial integration program.
- ----Or family members whose "spare"
kidney is a life-saving match for a patient sometimes agree to be a donor
while hiding deep anxieties and a strong desire not to donate.
- Physicians who recognize such a situation
will sometimes honor the unwilling donor's unexpressed wishes by reporting
falsely that he or she was not a good tissue match.
- There are other dilemmas not mentioned
in the early editions of "Lying."
- For example, genetic tests for newborn
babies, developed in the last decade, can reveal that the husband is not
the baby's father. Must the doctor tell?
- And in Oregon the new law allowing physician-assisted
suicide (PAS) has created truth-telling dilemmas. Doctors are not required
to participate in PAS if it violates their conscience, but are required,
as in all medical procedures, to refer the patient to another physician.
But they are not required by law to tell the patient about PAS while discussing
end-of-life care. Do they have a moral duty to tell, when not telling limits
the choices of the patient?
- Bok made two daunting discoveries while
researching her book.
- ----"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. Doctors want the option of lying left open, Bok found, because
of "a severely restricted and narrowed paternalistic view -- that
some patients cannot understand, some do not want, and some may be harmed
by knowledge of their condition."
- ----"Many physicians talk about
such deception 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."
- This is an outgrowth of the old paternalistic
model of medical practice, in which the doctor is the lord of the castle,
up on the hill, and the patient is the village idiot down in the flatlands.
- Both these situations have changed since
"Lying" was first published. Many medical schools now have ethics
courses, and truth-telling is stressed. Most physicians consider truth-telling
an important ideal -- though many still find rationalization for the "therapeutic
- The burden of proof has to fall increasingly
on the physician who wants to bend the truth; it can't any longer be done
casually or condescendingly. Bok offers three reasons for telling patients
- ----The medical and psychological benefits
to them from this knowledge.
- ----The unnecessary and sometimes harmful
treatment to which they can be subjected if ignorant.
- ----The harm to physicians, their profession
and other patients as a result of the lie.
- BRUCE HILTON, director of the National
Center for Bioethics, has been an ethics consultant to doctors, hospitals
and patients since 1972. He can be reached at 70523.1071@CompuServe.com.