American citizens demand ethical medical care besides the ordinary affordable medical care. Ethical principles are prerequisite to ensure patients’ protection, guarantee integrity, to sustain least standards of quality, and to curb extravagant and deceitful expenditure of medical care resources. Therefore, without the protection of ethics, the medical care organization will be an analogy of a financial jungle, within which the fast and the superior will enjoy enormous financial gain over the sick and the susceptible. Obviously, such a setting would not appeal to the public when they are sick, vulnerable or weak (Miller, 1998). Americans are increasingly finding out that the managed care system mostly does not meet the expectations of the consumers. The managed care system focuses primarily on reducing cost to increase profits, while its consideration on the ethics and quality of care comes second. In spite of the widespread reports by the media and medical care practitioners on unethical managed care practices, the managed care sector is not responding positively to the allegations (Miller, 1998).
The ethics literature dealing with deceit of patients dedicates a lot of its resources to uncover the definition of deceit.
In this context I will explore beyond the direct passing on false information. This paper will also include the deliberate decision to hold back from the terminally ill patient information which, the physician contemplates to have a crucial impact on the patient. Based on this definition, deceiving a cancer patient who wishes to know his or her diagnosis, will entail falsehood surpassing the act of merely telling the patient that he is cancer free. It will as well encompass half-truths intended to deceive, for instance the respond that s/he has a metaplasia or elusion with an equal objective, such as uttering deceitfully that there is not yet sufficient information to discern. In day to day terms, distinction between deceit, half-truths and elusions, although such distinctions do not play a major part in ethical debate concerning these issues and they are generalized as deceit (Ryan, Moore, & Patfield, 1995). The ethical concern emerging from a physician’s prospect to deceive a patient have transformed within the past two centuries.
This period has corresponded with enhanced knowledge of the concerns for the general medical ethics, which has been facilitated through an improved public training, an improved public appreciation of individual privileges, and the mushrooming of medical consumer associations and patient representative (Mitchell & Terence, 1991). Prior to the referred period, it was basically thought that deceit of patients was reasonable in specific situations and, in fact it was commonly regarded as a Nobel ethical and medical practice (Lipkin, 1991 cited in Ryan, Moore, & Patfield, 1995). The basis for such perspective was seldom defined, although it was normally based on primum non nocere [the doctor’s maxim]; implying that despite everything he or she must not harm the sick (Meyer, 1969 cited in Ryan, Moore, & Patfield, 1995).
Argument for medical dishonesty
Various arguments have been raised to account for an act of dishonesty towards patients, including; (a) on certain situations when telling the truth may harm the patient, (b) physicians should not be the source of patient’s pain, and (c) in such situations the doctors are obliged to refrain from telling their patients the truth (Ryan, Moore, & Patfield, 1995). Basically the argument can be convincingly demonstrated using a clinical vignette. This scenario usually entails an elderly terminally cancer patient left with a short time left before s/he dies. It is supposed that telling such patient the truth about her fate and that such an act will only serve to exacerbate her condition. It is far much better to keep her in the dark, with a fabrication. The incidence of such principle was evident in different research studies in the 1950s and 1960s verifying that physicians tended to withhold information about diagnosis from their cancer patients (Oken, 1976 cited in Ryan, Moore, & Patfield, 1995).
Changes in traditional premises
Presently, with regard of disclosure of truth to patients about their cancer diagnosis, seem to have taken a new direction (Novack, Plummer, & Smith, 1979 cited in Ryan, Moore, & Patfield, 1995). Despite the arguments for its past appeal, this position has few supporters in contemporary medical ethics literature.
Two connected objections have been proposed against the traditional viewpoint. The first re-checks the basis of the previous argument, whereas the second bring in the idea of autonomy. The first objection refutes both basis of the argument. The proceeding paragraphs will explore on the amendment of the two traditional premises for lying to patient. Premise 1 asserts that in certain circumstances disclosing the truth is associated with more harm compared to the harm caused when lying to the patient (Buchanan, 1978). To holdback from the terminally ill patient the gravity of her impeding end, translates to his deprivation of the opportunity to just say goodbye, to resolve past scores, or to put his or her affairs properly. Progressively, perhaps the patient may contemplate the gravity of the condition and embrace the ideology that she is approaching death (Kubler-Ross, 1969, cited in Ryan, Moore, & Patfield, 1995), such that there will be no gain and may cause the patient to lose faith with the family members and the physician. Obviously, most patients manage well the awareness of there imminent demise and some are actually calmed by it (Kubler-ross, 1975, cited in Ryan, Moore, & Patfield, 1995).
Clearly, the patient does not gain anything from the physician’s deceit (Bok, 1978 cited in Ryan, Moore, & Patfield, 1995). Secondly, the same objection refutes the diction of premise 2. As a matter of fact, the physician’s roles extend far past the patient he or she is attending. He or she must take into consideration the wellbeing of the community as well as other patients. Taking into account the expanded responsibilities, the premise 2 changes as described in the following paragraph (Ryan, Moore, & Patfield, 1995). The second premise asserts that doctors should not be responsible whatsoever in harming the patient. If the deceit of terminally ill patients is publicized, it means that other patients are anxious of their imminent demise may lose faith in their physicians and probably imagine the worst. Clearly, this unprecedented practice has adverse implications on other patients (Ryan, Moore, & Patfield, 1995).
With the implementation of theses novel premises, it is clear that this exposes the doctor to a dilemma. How will she be able to tell when a lie may cause more good than harm? She would not be able to tell due to the numerous factors to take into account and the best option is one that will cause minimal suffering, which is by consistently telling the truth (Buchanan, 1978). The second objection integrates the notion of autonomy; self-sufficiency. Usually, mature persons have the ability to make decision concerning their lives, so that they focus the path of their destiny. Such objection purports that individuals have the privilege to implement that ability whether or not it causes harm. A person cannot successful practice own autonomy in case s/he does not have enough information to base her or his decisions.
Thus, to holdback information from a patient translates to restraining his or her autonomy an act which the physician has no entitlement to (Robinson, 1973 cited in Ryan, Moore, & Patfield, 1995). Physician must tell the truth all the time. A few researchers, nevertheless, still maintain that although a direct lie may be harmful, ‘benevolent deception’ is tolerable (Jackson, 1991). This concept is different from lying in the a daily sense and concerns distortions, elusions and attempt to white wash a patient that is sufficient to qualify as an outright lie. This maneuver possesses a characteristic which relates to how well it suits the ethics of the ‘white lie’. In fact even the researchers who oppose it, have problem with evading its influence (Bakhurst, 1992). Futuristically, benevolent deception will not succeed in quelling the opposition to aforementioned deceit.
Health care service consumers who access information on the unethical health care practices have an upper hand in maneuvering through current managed health care processes.
Furthermore, certain steps should be taken to curb the ethical decline in health care system. With the increasing knowledge on ethical issues in the health care delivery system, the consumers and professionals can collaborate to campaign against unethical practices such as this.
Bakhurst, D. (1992). On lying and deceiving. Journal of medical ethics; 18: 63-66. Buchanan, A. (1978).
Medical paternalism. Philosophy and public affairs; 7: 371-390. Jackson, J. (1991).
Telling the truth. Journal of medical ethics; 17: 5-9. Miller, I. (1998). Eleven Unethical Managed Care Practices Every Patient Should Know About.
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, & Patfield, M. (1995). Becoming none but tradesmen: lies, deception and psychotic patients. Journal of medical ethics; 21: 72-76 doi: 10.1136/jme.21.2.72