Telling the Truth to Patients:

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Telling the Truth to Patients A Clinical Ethics
Exploration David C. Thomasma
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WHY TELL THE TRUTH? I

• Three principal reasons for telling the truth
  that are identified by David Thomasma are
• It is a right, a utility, and a kindness to be
  told the truth.
• It is a right to be told the truth since respect
  for persons demands telling the truth.
• As Kant recognized, human society would collapse
  without truth telling.
• Telling the truth is the basis of trust,
  agreements, contracts, and promises.

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WHY TELL THE TRUTH? II

• Truth is a utility - something useful - because
  we need to make informed judgements about our
  actions. And it is difficult to make an informed
  or proper judgement when the judgement is based
  on faulty information given in a lie.
• It is a kindness to be told the truth, and where
  the kindness is rooted in the virtue of truth
  telling that recognizes the baleful effects on
  individuals of telling lies.

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OVERRIDING THE TRUTH I

• Must the truth always be told, or might other
  moral considerations override the truth in
  certain situations?
• Thomasma thinks that telling the truth can be
  overridden when the well-being of an individual
  or the survival of the community is at stake.
• He also asserts that, for paternalistic reasons,
  and without the patients consent, the right to
  be told the truth can be overridden in favor of
  other moral considerations.
• Necessary paternalism is aiding or protecting a
  person from harm who is incapable of aiding or
  protecting himself do to a serious illness.

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OVERRIDING THE TRUTH II

• Thomasma The only values that can trump the
  truth are recipient survival, community survival,
  and a persons or groups ability inability
  to absorb the full impact of the truth at a
  particular time.
• All of these are only temporary trump cards in
  any event.
• They only can be played under certain limited
  conditions because respect for persons is a
  foundational value in all relationships.
• And part of that respect is telling persons the
  truth.

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HEALTHCARE GOALS I

• Thomasma The goal of all healthcare relations
  is to receive or provide help for an illness
  and/or injury such that no further harm is done
  to the patient, especially in that patients
  vulnerable state.
• The vulnerable person should be assisted back to
  a state of human equality, if possible, free from
  the dependency that the patient has due to
  his/her vulnerable condition.

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HEALTHCARE GOALS II

• Thomasma says that a medical professional should
  attempt to restore his or her patients autonomy
  being healthy enough to be self-governing and
  to make free choices.
• Respect for the truth is measured against this
  goal.
• If the truth would impair the restoration of
  autonomy, then the truth may be withheld on
  grounds of potential harm to the patient.

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TIME, TRUTH, AND RELATIONSHIPS I

• Thomasma points out that most interventionist
  healthcare relationships are temporary, whereas
  relationships involving primary care, prevention,
  and chronic or dying care are more permanent.
• Telling the truth is required more in temporary
  medical relationships between strangers where
  important decisions need to be made in a short
  time to benefit the patient even if there are
  concerns about the truths impact on the person.

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TIME, TRUTH, AND RELATIONSHIPS II

• Thomasma Over a longer period, the truth may be
  withheld for compassionate reasons more readily.
• Here the patient and physician and nurse know
  one another. They are more likely to have shared
  some of their values.
• In this context, it is more justifiable to
  withhold the truth temporarily in favor of more
  important long-term values, which are known in
  the relationship.

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ILLNESS AND DISEASE I

• Thomasma says that disease is a subset of
  illness.
• An illness is much broader than a disease.
• An illness is a disturbance in the life of the
  ill person.
• A disease is a medically caused event or
  condition that may or may not respond to
  treatment.

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ILLNESS AND DISEASE II

• Thomasma Helping one through an illness is a
  far greater personal task than doing so for a
  disease.
• A far greater, more enduring bond if formed.
• The strength of this bond may justify
  withholding the truth.
• For Thomasma, truth is essential for healing an
  illness. It may not be as important for curing a
  disease.

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TRUTH IN MEDICINE I

• Thomasma thinks that physicians telling the truth
  to their patients - even in cases of diseases for
  which we have no cure - seems today to take
  precedence over protecting the patient from
  imagined harms, such as that the person may not
  be able to handle the truth.
• Thomasma says that truth in the clinical
  relationship is factored in with knowledge and
  values.
• Thomasmas saying that truth is contextual in
  medicine means that it depends on the nature of
  the relationship between the doctor and patient
  and the duration of their relationship.

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TRUTH AS A SECONDARY GOOD

• Saying that truth is a secondary good means that
  other values can take precedence over telling the
  truth.
• The most important are the survival of the
  individual and the survival of the community.
• Also important is the preservation of the
  doctor-patient relationship.

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TRUTH IN MEDICINE II

• Thomasma says that withholding the truth is
  temporary. This is because the truth has a way
  of coming out.
• Revealing the truth to a patient must always aim
  at the good of the patient for the moment.
• At all times, the default mode should be that
  the truth is told.
• If, for some important reason, it is not to be
  immediately revealed in a particular case, a
  truth-management protocol should be instituted so
  that all caregivers on the team understand how
  the truth will eventually be revealed.