dishonesty in diagnosis

[the tooth]

if a patient is in end stage CA, and the location of the CA will cause significant psychological harm, can patient be told that the primary is in a different location, so long as the CA is not hereditary? patient has psych illness.

[leslie :-D]

no.

it is never ethical to lie.

morally, it may be the kinder action.

but regardless of a pt's mental/psych status, everyone has the right to know the truth-

unless, they state they don't want to know.

but even then, an omission is not the same as skewing the facts.

leslie

[Tweety, BSN, RN]

So your saying the patient has a pysch. illness (it's unknown to us at this time the severity) and telling them the true primary site will cause, as you say "significant psychological harm".

That's a tough one. Will make an interesting thread. A blanket statement that one must 100% of the time be 100% honest might not always be appropriate 100% of the time.

If I were the MD, I would be in collaboration with the psych team, social worker, etc. on this one and come up with a collaborative approach.

[the tooth]

thank you. both of your comments are very helpful. do you know where i could find legal/ethical support for both sides of the coin?

[pebbles, BSN, RN]

Seems very paternalistic to me. I don't like it.

There are ways to communicate the truth to people, even if it's awful, in a caring, sensitive manner. And you always support them along the way. If it's done well, and with good ongoing communication, telling the truth is the way to go.

[sirI, MSN, APRN, NP]

Excellent PDF on physician code of ethics. Just an excerpt. Please read in its entirety about, "therapeutic privilege" and withholding information:

1. WITHHOLDING INFORMATION FROM PATIENTS

HOUSE ACTION: FILED

At the 2006 Annual Meeting, the American Medical Association House of Delegates adopted the recommendations of Council on Ethical and Judicial Affairs Report 2-A-06, "Withholding Information from Patients (TherapeuticPrivilege)." This report advises physicians to share information with their patients in a timely and sensitive manner, and to refrain from withholding information in an attempt to minimize potential physical or psychological harms, a practice known as the "therapeutic privilege." The Council issues this Opinion, which is based on CEJA Report 2-A-06. It will appear in the next version of PolicyFinder and the next print edition of the Code of Medical Ethics.

http://www.ama-assn.org/ama1/pub/upload/mm/38/i-06ceja.pdf

[leslie :-D]

couple more links.

Ethics and Medicine

Truth-telling and Withholding Information

http://www.depts.washington.edu/bioethx/topics/truth.html

Bioethics for clinicians

7. Truth telling

http://www.cmaj.ca/cgi/reprint/156/2/225.pdf

leslie

[BluntForceTrauma]

It doesn't seem very ethical to me to lie to someone about their diagnosis.

[pebbles, BSN, RN]

It used to be the practice many years ago in some places to not tell people the whole truth, or even lie. It wasn't as much part of the profession as it is now to teach and explain fully to people what was going on with their health and body.

Now we're paying the price for some of that attitude in the form of passive patients who don't want to be involved or understand what is wrong with them and their treatment. AND we have the people who are paranoid and accusatory because they feel like we're hiding things from them. That suspicion was borne out of our own past practices.

People need to be able to trust their care providers - one lie can break that person's trust forever. It's not worth it. Especially is someone is vulnerable in end stage CA and needs to rely on health care providers for so much...

[steelcityrn, RN]

I say truth first then hope. If you take a persons hope away, you then can count on a death.

[P_RN, ADN, RN]

Truth.

[CHATSDALE]

i vote for truth,

if you lie then you are obligating all other staff members to lie to uphold your lie