Section 3. Presentation of Issues: TRUTH
Truth promotes respect for individuals and supports
Traditional Arguments against truth telling
Sissela. (1996). Lies to the sick and dying. In R. Munson, Intervention
and Reflection: Basic Issues in Medical Ethics (5th ed.)Scarborough,
Ontario: Wadsworth Publishing Company.1996, pp. 290-297).
Three reasons for not telling the truth:
- it is not possible to present the truth in
a manner that he patient would understand
- the patient would not want the truth, they
do not want to know
- the truth may harm the person, they may
lose all hope if they know the truth
Counter arguments against the case for not telling
the truth. Against the three reasons:
- vs 1. It is not always true, it might depend on how
the information is presented.
- vs 2. Facts don't support this claim. Studies
indicate that people do want to know the truth
- vs 3. a number of points
- a. harm resulting may be and often is much less than
the HCP estimates
- b. estimates of possible harm are more often
based on fears of the HCP than on documented behvior of the recipient of
- c. the harm resulting may be justified and
acceptable to the recipient but simply not accepted by the HCP
- d. benefits from disclosure of the truth are more
substantial than most HCP believe
- e. lies violate autonomy and self
- f. ignorance often leads to hopelessness
- g. lies harm collegial relationships, family
- h. lies harm the HCP-recipient relationship, TRUST
is needed for therapy!!
Argument for HONESTY:
- provides respect for a person's dignity
- provides mental ease.
- provides an emotional handle in the struggle to
accept reality, even death.
- assists a person to maintain control.
- recognizes Autonomy of persons and the right to
Physicians must act in the best interest of those
Should the physician lie or withhold information in
the best interests of those being given care or treatment? Who is to decide?
Based upon what reasons?
A primary ethical issue that arises with the use of
placebos is a need to balance concern for beneficence (doing good for the
recipient of care ) with respect for the autonomy of the recipient of care. To evaluate
the morality of using placebos, one needs to consider both of these lines of
thought. On the one hand, placebos usually involve the use of deception,
which, despite the goal of beneficence, runs the risk of failing to respect
autonomy. On the other hand, if one sees beneficence as a primary
obligation, then one may believe that the deception involved is problematic
only to the extent that it is likely to create harms that outweigh benefits.
Reasons against the use of placebos:
- it is a deceit
- encourages belief in drugs
- deprives recipient of care of a chance to make a decision
- deprives recipients of care of more effective and
Is the deception justified?
Arguments for and against are included in
The lie that heals: the ethics of giving placebos
additional resource: Gregory S. Loeben, PhD: The Ethics of
Prescribing Placebos: A Case of the Ends Justifying the Means?
Medical Crossfire 2000; VOL 2, NO 3: 76-81
From the University of Washington School of
- Do patients want to
know the truth about their condition?
- How much do patients
need to be told?
- What if the truth could
- What if the patient's
family asks me to withhold the truth from the patient?
- When is it justified
for me to withhold the truth from a patient?
- What about patients
with different specific religious or cultural beliefs?
- Is it justifiable to
deceive a patient with a placebo?
Truth-telling and Withholding Information by
Clarence H. Braddock
Consensus Report Defends Ethics, Utility of
Placebo in Clinical Trials of Mood Disorders,
NeuroPsychiatry Reiews, Vol.3, No.4,May, 2002
Health officials debate
ethics of placebo use
By Susan Okie / The
Washington Post , November 25, 2000
WASHINGTON -- Researchers, ethicists and health officials
attending a conference at the National Institutes of Health this week
defended the use of placebos -- inert, dummy medicines -- as an essential
tool for evaluating new drugs, and said giving them to patients in a study
often can be justified even when there already is a treatment that works.
"There has been a great shift taking place about placebo use," said
Sissela Bok, a philosopher and senior fellow at the Harvard Center for
Population and Development Studies. "What is clear is that the ethical
issues are nowhere near resolved."
Giving placebos to study participants has ignited a fierce ethical
debate, after last month's revision of a key international medical document
to declare their use unethical whenever the disease being studied already
has an effective treatment.
The document, the Declaration of Helsinki, was revised to state that
experimental therapies always should be tested against "best current"
treatments and that placebos should be used only when no treatment exists.
The changes were made after controversy arose over studies conducted in
Africa and Asia of experimental treatments to prevent pregnant women from
transmitting the AIDS virus to their infants. An effective treatment already
was in routine use in industrialized countries, but was unavailable in the
countries where the research took place. Some study participants were given
of article at:
From the University of Washington School of Medicine
Breaking Bad News
- Robert Buckman's Six
Step Protocol for Breaking Bad News
- What if the patient
starts to cry while I am talking?
- I had a long talk with
the patient yesterday, and today the nurse took me aside to say that the
patient doesn't understand what's going on! What's the problem?
- I just saw another
caregiver tell something to my patient in a really insensitive way. What
should I do?