COMMENTARY
The ethics of lying
BY EDWIN T. MELENDEZ-MURPHY, MD Medical ethics statements on lying are ambiguous. An American Medical Association pol- icy on the patient-physician relationship states, “The relation- ship between patient and physician is based on trust and gives rise to physicians’ ethical obligations to place patients’ welfare above their own self-interest and above obligations to other groups, and to advocate for their patients’ welfare.” The statement doesn’t address lies specifically. Logically, trust cannot exist if the patient discovers a lie.
The amount of truth a physi-
cian provides is often referred to as therapeutic privilege. An hon- est discussion of the use of this privilege ensures a therapeutic relationship among patients and physicians that extends to the health care system and society. A study titled “Survey Shows
could be considered beneficence. In this case, beneficence out- weighed autonomy, justifying the lie. Patient-physician communication scenarios like this arise
Often, the decision to tell the truth comes naturally.
That At Least Some Physicians Are Not Always Open or Honest With Patients” published in 2012 in Health Affairs shows lies are commonplace among physicians. I heard a story on the radio about a nursing home in Ger- many that had a problem with wandering Alzheimer’s patients. When patients disappeared, the police had to collect and return them. The home’s unique solution to the problem involved developing a ruse to trick patients who tried to wander. The nursing home built a fake bus stop right outside. A re- markable thing happened: The patients who wandered were found sitting at the bus stop. The staff would coax them back into the home without the stress of having to restrain them or call the police.
Analyzing the ethics of lying in this story requires balanc-
ing the core ethical tenants of autonomy and beneficence. The patients at the nursing home lacked total autonomy. Return- ing them by force caused them severe stress that, if avoided,
Sometimes, it’s not so cut and dry.
throughout physicians’ careers. Often, the decision to tell the truth comes naturally. Sometimes, it’s not so cut and dry. As an intern, I lied to a patient receiving a cardiac cath- eterization. The cardiologist had already read the results and told me the patient wasn’t likely to live longer than three months. When I met the patient, he asked me what the catheteriza- tion showed. It was my under- standing the cardiologist would discuss the results, but I was the first physician to speak to the pa- tient after his procedure. I told the patient I was not fully aware of the results and said the cardiologist would dis- cuss his findings.
I have told this story to oth- ers, and they usually question whether I had lied to the patient. They say I simply delayed the communication of information. I understand that argument, but I see value in calling what I did
lying. Acknowledging my lie forced me to look for an ethical justification for my actions.
I justified my lie with the knowledge the cardiologist would speak with the patient and share the diagnosis. I believe if I had divulged the prognosis I would not have had the medical knowledge to accurately answer all of the patient’s questions. The decision to tell the complete truth will come easy to most physicians. But lies are sometimes necessary. The need to lie in more ambiguous cases will be a constant dilemma for medical professionals. n
Edwin T. Melendez-Murphy, MD, is in The University of Texas Southwestern Medical School’s Austin Family Medicine Residency Program. Before that, he served as a naval flight surgeon.
September 2014 TEXAS MEDICINE 7
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60