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Philosophy - Biomedical Ethics: Lying and Withholding Medical Information are Forms of Deception
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Philosophy - Biomedical Ethics: Lying and Withholding Medical Information are Forms of Deception
Introduction
In today’s clinical practice, physicians who lie to their patients are harshly condemned while those that engage in non-deceptive strategies such as information withholding often face less criticism (Cox & Fritz, 2016). While some of these non-disclosure strategies have in recent times been challenged, such as withholding important information regarding medical errors and inadequately providing information to patients about the risks of certain procedures, there are areas of clinical practice where information non-disclosure is largely acceptable. It is often agreed that building trust between a physician and their patients is an essential element to strengthen their relationship and improve patient outcomes. In this regard, there some forms of behaviours such as lying, which physicians should never engage in because they directly undermine trust. At the same time, confidentiality is equally important to foster the relationship between physicians and their patients, but this has to be within given limits such as in cases where patients are likely to unknowingly infect others with HIV/AIDS (Benn, 2001). Should withholding be considered as morally equivalent to lies, if lying is wrong? In this paper, I argue that deception is morally wrong and it is therefore never acceptable to lie or withhold information from patients. I will first show that there is no difference between the act of lying and withholding the truth as the two are equally wrong. Secondly, I will argue that “paternalism” largely contradicts the principles of “patient autonomy” and show how the concept of “therapeutic privilege” challenges the principles of “non-maleficence” and “beneficence”. Lastly, I will dismantle Mack Lipkin’s argument and argue against his premises as I believe it is the physician’s role to always disclose important patient information truly and fully.
Patients’ expectations and the role of the doctor in the patient-physician relationship are changing. Patient autonomy is fundamental, yet challenging, principle of professional medical ethics. The idea that individual patients should have a freedom to make choices about their lives, including medical matters, has become increasingly prominent in the current health care profession. However, this has not always been the case in the past, since physicians were the ones to make the decisions for their patients if they were perceived to not have the capacity to behold the truth. This action is justified by the theory of paternalism, which places physicians in positions of authority, and allowed them to make choices for their patients as a promotion of their welfare (Fisher et al, 2018, p.9). For the purpose of this paper, we will consider paternalism in the context of telling the truth and withholding information, which then raises the question: If lying and withholding is a form of deception, then is it ever permissible to deceive patients for “their own good”?
Therapeutic privilege allows physicians to withhold information from a patient if it is perceived that full disclosure will have both psychological and physical detrimental effects (Bassford, 2017). Richard and Lajeunesee (2010) argue that in any circumstances, if disclosing information that causes potential harm to patients, such as disclosing discouraging information, then they should withhold the information. I argue that the therapeutic privilege in this case is parallel to the principles of beneficence and non-maleficence. Beneficence insists that a physician must do good and non-maleficence, and I also state that a physician should do no harm to the patient. This paper also considers paternalism in the context of telling the truth and withholding information, and examines the significance of providing the patients with full information before initiating the treatment procedure.
Some scholars have argued that providing full information to patients may at times negatively affect their wellbeing and health. Studies have shown that in 1961, less that 10% of health care practitioners believed that patients should be told that he/she is suffering from a fatal diagnosis of cancer, yet by 1979, 79% of these physicians held that it was crucial to reveal this information to patients (Stewart, 2010). Hypothetically, a teenager comes in for birth control prescription and her physician prescribes Depo-Provera and only discloses certain risks that he thinks are relevant to the patient. However, the physician does not tell the patient that birth control can increase her chance of having breast cancer, because the chance of someone getting breast cancer in their teenage years is extremely rare.
In this case, the physician’s reason of not disclosing this information can be justified by the theory of therapeutic privilege. By revealing this uncommon risk, it can discourage the patient from getting the birth control medication. Therefore, the possibility of the patient having an unplanned teen-pregnancy is more realistic than her developing breast cancer. Additionally, the consequences of an unplanned pregnancy outweigh the improbable chances of developing breast cancer. Contrarily, what if she decided to use this method of contraceptive only to later find out the prescription could increase her susceptibility of breast cancer? Assuming the patient is more concerned about the possibility of breast cancer than unplanned pregnancy, she could not have made an informed decision without knowing all the potential side effects.
If she had only known of such a risk, she might not have made the decision she did. This will leave her feeling regretful of her decision. Patients rely on their doctors to be honest with them about their conditions, and form a working relationship with them. What would happen to such a relationship when there is an element of lying from the physician? The relationship is destroyed and can result in diminished screenings, late diagnosis, and delay treatment in the future. In this case, it was one physician, but what if every physician act upon the therapeutic privilege that allows them to choose what and how much information to disclose, then whom can patient trust, who will they go to if they need medical care in the future? The example demonstrates how therapeutic privilege challenges the principles of beneficence and non-maleficence. So then, do therapeutic privilege ever outweigh the need for truth?
Certain scholars argue that prolonged life of the patient should take precedence even if it means withholding information. However, Immanuel Kant argues that human dignity should be respected since all individuals have the ability of living autonomously. This implies that people live in accordance to the laws and policies that have been implemented by government authorities, and also in accordance to their distinct abilities to decide which policies should be used to govern them (Kluge, 2004). This is the literal meaning of the term autonomy. Kant is of the opinion that people should not be given the absolute powers of making decisions for others, and it is from this perspective the it can be argued that physicians should allow their patients to access the full information about their conditions (Stewart, 2010). When physicians are allowed to have the full autonomy of making decisions for other people, then it will mean that the society is failing to respect the autonomy of other people.
When it comes to models that represent the relationships between physicians and patients, it appears that the society has diversified from paternalistic models to informative models. Stewart (2010) argues that paternalist models empowered health care personnel to ac...