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7 - Truthfulness

from Part II - Moral foundations of the therapeutic relationship

Published online by Cambridge University Press:  05 February 2016

John C. Moskop
Affiliation:
Wake Forest University, North Carolina
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Summary

Case example

Twenty-two-year-old Annie was brought by friends to the ED of a small Virginia hospital. She fell while horseback riding, was kicked by her horse, and lay in a field for several hours. Despite initial IV therapy, her blood pressure remains very low, and an abdominal tap reveals that she is bleeding very rapidly into her abdomen.

Though she is in shock, Annie remains awake and alert. She asks Dr. Smith, the emergency physician caring for her, “Is it a serious injury? Will I live?”

Dr. Smith responds, “Everything will work out, Annie. It may be a little rough for a bit, but it will work out.”

“Are you sure?” she asks. “Please, tell me honestly.”

Dr. Smith is very concerned about Annie's unstable condition, and he is unsure how she will do. What should he say to her?

Past and present

In twenty-first-century Anglo-American societies, truthfulness is widely acknowledged as a central professional responsibility of physicians. Professional standards regarding truthfulness have, however, undergone significant change over the past century, and what constitutes truthful communication is still a matter of some controversy. Other cultures, moreover, endorse somewhat different approaches to communication between physicians and patients. This chapter will examine the meaning and justification of truthfulness in the therapeutic relationship.

In an article published in 1903, physician Richard Cabot states the “rule for truth-speaking” he was taught as a Harvard medical student: “When you are thinking of telling a lie, ask yourself whether it is simply and solely for the patient's benefit that you are going to tell it. If you are sure that you are acting for his good and not for your own profit, you can go ahead with a clear conscience.” As this rule illustrates, the medical profession of that era condemned self-serving lies, but approved lies told for the benefit of patients. Notice that the rule authorizes the physician to judge whether truthful or deceptive information will do more good for the patient, and to base his or her disclosure on that judgment.

This rule Cabot cites appears to have persisted well into the twentieth century. In a survey of 200 Chicago physicians published by Oken in 1961, almost 90 percent of the respondents reported that they generally withheld information about a cancer diagnosis from their patients.

Type
Chapter
Information
Ethics and Health Care
An Introduction
, pp. 90 - 100
Publisher: Cambridge University Press
Print publication year: 2016

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References

Bonhoeffer, Dietrich. 1965. What is meant by “telling the truth”?In Ethics. New York: Macmillan: 363–372.Google Scholar
Cabot, Richard. 1903. The use of truth and falsehood in medicine: an experimental study. American Medicine 5: 344–349. Reprinted in Reiser, Stanley J., Dyck, Arthur J., and Curran, William J. (eds.) 1977. Ethics in Medicine: Historical Perspectives and Contemporary Concerns. Cambridge, MA: The MIT Press: 213–220.Google Scholar
Freedman, Benjamin. 1993. Offering truth: one ethical approach to the uninformed cancer patient. Archives of Internal Medicine 153: 572–576.CrossRefGoogle ScholarPubMed
Novack, Dennis H., Detering, Barbara J., Arnold, Robert, et al. 1989. Physicians’ attitudes toward using deception to resolve difficult ethical problems. JAMA 261: 2980–2985.CrossRefGoogle ScholarPubMed

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  • Truthfulness
  • John C. Moskop, Wake Forest University, North Carolina
  • Book: Ethics and Health Care
  • Online publication: 05 February 2016
  • Chapter DOI: https://doi.org/10.1017/CBO9781139058575.010
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  • Truthfulness
  • John C. Moskop, Wake Forest University, North Carolina
  • Book: Ethics and Health Care
  • Online publication: 05 February 2016
  • Chapter DOI: https://doi.org/10.1017/CBO9781139058575.010
Available formats
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Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

  • Truthfulness
  • John C. Moskop, Wake Forest University, North Carolina
  • Book: Ethics and Health Care
  • Online publication: 05 February 2016
  • Chapter DOI: https://doi.org/10.1017/CBO9781139058575.010
Available formats
×