Telling the truth to a patient regarding diagnosis, whether desirable or devastating, is pertinent in the healthcare practice since it fosters trust and respect for the affected patient. Patients have much vested trust in their healthcare providers. They may lose this trust if they discover or suspect that a healthcare worker is providing false information to them. Contrary to traditional misconceptions regarding the importance of hiding true diagnosis to a patient to avoid panicking, research has demonstrated that most patients want a case where their care providers tell them the truth regarding their diagnosis. Besides truth telling by care providers reinforcing trust from the patient, honest information provides insight to the patient. Such insight may assist the care providers in making vital lifesaving decisions regarding the best course of therapy. Therefore, it is important for patients to be told all the relevant details about their condition, including the expected clinical outcomes, with a sensible range of treatment regimens, benefits, and risks of the alternative treatments. Moreover, all information that may be perceived paramount to the patient’s personal needs, beliefs, and values should also be disclosed. As the paper reveals, although some situations may need moderation during disclosure of devastating diagnosis to a patient, it is important for healthcare providers, including nurses, to provide truthful information to their patients to avoid breaking trust. This plan allows patients to participate in the making of important decisions regarding their treatment.
Comparing Traditional Misconceptions and Current take on Patient Veracity
Traditional conceptions dictated that patients should not be told the truth about a devastating diagnosis to avoid causing harm to them. In other words, the justification was that the move could allow the patient to be stress-free during the treatment process. In addition, care providers lied to their patients regarding their condition to escape the difficulty of relaying the bad news in a way that was too brutal to damage the patient’s emotions. According to some moral philosophers such as Drane and Reich (2002), telling the truth to patients regarding a devastating diagnosis was the only reasonable exception to the moral imperative of telling the truth. Consequently, care providers’ moral duty was to assist and not cause harm to the patient. Therefore, whatever the care providers said to their patients was critically judged based on its outcome on these essential duties (Drane & Reich, 2002).
Today, much has changed regarding the subject of truth telling. Under the current practice, truth is considered a principle of medical ethics. Additionally, from a clinical and social context, the importance of telling the truth cannot be overemphasized. According to critics as Drane and Reich (2002) confirm, justifications that support lying to patients express the liars’’ perspective while failing in recognizing the patients’ position and take. In most cases, patients and people in general get hurt when those whom they have invested their trust in deceive them (Drane & Reich, 2002).
The justification of dishonesty regarding distressing clinical diagnosis to patients had more to do with moral conjectures of ancient beliefs and culture. For instance, in Greek culture, a good healer/doctor treated the patient as a daughter or son. As a result, he or she was expected to do what was best for the patient without requiring any form of consent from the patient. Today, because patients can (and must) consent to any clinical decision regarding their treatment, truthful disclosure of essential information concerning a patient’s condition is both an ethical and legal obligation on the part of the healthcare provider.
Modern codes of ethics in the medical field reflect the shift in the importance of truth telling. For instance, according to the moral code of ethics of the American Nurses Association, clients possess a moral right to be provided with accurate and truthful information. It also appeals to nurses to avoid false deceptions and/or claims. Additionally, according to the American Medical Association, the principle of medical ethics states that physicians are expected to deal with their patients with complete veracity. They are also encouraged to expose other physicians who practice contrary to this code.
Today, if a nurse decides to hide the truth from the patient after considering the clinical benefits and risks, he or she must be ready to withstand the burden of proof. Therefore, the nurse must be ready to defend the decision before other healthcare professionals who are involved in caring for the patient. Some of the patient’s family members, caretakers, or representatives must be told the truth. However, if a nurse is habitually dishonest to patients, he or she cannot be excused based on a clinical justification (Drane & Reich, 2002).
Truth-telling in an Ethical Context
Veracity is the first ethical responsibility of a nurse or any other healthcare provider. Upholding this principle in practice requires the nurse to include the comprehension of the personal beliefs and culture of the patient (Surbone, 2000). The truthful disclosure of information relevant to patients’ condition not only assists them to comprehend and deal with what is transpiring to them but also reinforces and helps in the maintenance of trust between them and the care provider. Patients should be told the truth as a sign of respect to them as autonomous persons. In addition, being dishonest to patients may cause harm to them. For example, patients who are not fully informed regarding their clinical condition may fail to seek medical care when they should. They may also make certain consequential life decisions that they may not have chosen to take if they had important information regarding their clinical state (Hébert, Hoffmaster, Glass, & Singer, 2007). Truth telling follows the principle of autonomy, which entails respecting the wishes of a patient. In the context of bioethics, autonomy refers to providing the patient the opportunity to make a choice of his or her treatment after he or she has been provided with the pros and cons of each alternative. This strategy gives the patient adequate understanding of what each treatment plan entails (Punjani, 2013).
Truth-telling in a Legal Context
From a legal perspective, truth telling goes beyond helping patients to make their autonomous treatment decisions. This viewpoint precludes providing an accurate and honest conveyance of information. Disclosure regarding diagnosis is required before, during, and after treatment of the patient. Many legal prosecutions result from communication issues that arise between patients and their healthcare providers. Therefore, timely and effective communication is instrumental to quality care. It can help to mitigate the risk of claims of malpractice. Healthcare providers, including nurses must ensure that they provide their patients with accurate and truthful information (Hébert et al., 2007).
Truth-telling in a Clinical Context
Nurses and other healthcare workers have the duty to uphold ethics in their profession. Moreover, they are also answerable to duties created by contractual agreements, institutional policies, and even family commitments. Such obligations complicate the arguments of the extent to which a nurse or care provider should disclose diagnostic information to a patient. Despite the many cultural and personal paternalistic beliefs by some nurses and practitioners that justify lying to a patient regarding a shocking diagnosis, patient veracity has many benefits that outweigh such sentiments. In fact, lying to the sick such as a dying patient may cause harm, rather than helping the patient (Drane & Reich, 2002).
Determining the extent of disclosure is also an important aspect of patient veracity. Nevertheless, lying in a clinical context is quite wrong for a myriad of reasons, unlike less than full revelation, which is a more justifiable course of action. For instance, in case of a depressed, suicidal, or irrational patient, caution is required not to fully disclose information to the patient.
Medical interventions have increased in number in the current age. Some of the healthcare professionals disclose information to solicit a certain treatment intervention to the patient or cover up their mistakes or for their selfish benefits. Likewise, health professionals may do as much harm by telling the truth in a cruel way. Hence, telling the truth to the patient regarding a devastating diagnosis entails that the nurse or medical practitioner using a compassionate, sensitive, and intelligent approach (Drane & Reich, 2002)
Challenges that Care Providers Face during Diagnostic Disclosure
Social and cultural differences are a challenge that nurses encounter during disclosure of devastating diagnosis to patients. Some cultures believe that ill people should be protected from injury or harm by concealing the truth about a distressing diagnosis or prognosis. For instance, in the Chinese culture, patients are not supposed to be told about a cancer diagnosis as a means of protecting them from being frustrated. They goal is to preserve the individual and family harmony. Such ideals also exist in the Taiwanese culture. Concerns voiced by physicians regarding the possibility of loss of hope by patient due to revelation of devastating diagnosis also played a huge influence in these cultural beliefs among different communities. In fact, some families are still afraid that knowledge concerning devastating diagnoses such as cancer can result in loss of hope, depression, and an increase in suffering for the patient. Nonetheless, technological advancements and the increasing knowledge dispel these beliefs. They encourage care providers to disclose relevant information to their patients.
Another challenge is the lack of proper communication skills by care providers when disclosing devastating diagnosis to their patients. Many nurses and healthcare providers do not harm their patients intentionally. However, failure by healthcare professionals to employ skills while conveying bad news in a sensitive and honest way can severely damage a patient’s ability to cope with their ailment and/or prepare for their inevitable death. As a result, nurses and care professionals should carefully decide to whom and/or to what degree the truth should be told to the patient, including how best this information should be relayed. However, some critics such as Zahedi (2011) argue that the healthcare provider should not entirely decide the extent of disclosure. He or she should first evaluate the needs of each patient and use his or her subjective experience to make a clinical decision. Paradoxically, care providers do not have a right of being untruthful to their patients, although they are not obliged to provide the whole truth (Zahedi, 2011).
Benefits of Truth Telling to Patient and Care Provider
Connections between the patient and the nurse should be therapeutic. Truth is an important aspect in building a strong therapeutic relationship with any patient. As a result, therapeutic relationships are based on trust between the patient and the healthcare professional. Strong fiduciary relationships between the nurse or care provider and the patient are closely associated with effective execution of therapeutic treatment with high probability of positive outcomes (Grace, 2009).
Telling the truth to the patient is important for his or her wellbeing. By providing all diagnostic information to the patient, trust between the healthcare provider and the patient is enhanced. As a result, patients’ conviction of confiding in the care provider increases because of their confidence in the healthcare workers’ insight. Research by Swaminath (2008) indicates that therapeutic intervention is more likely to succeed if the patient has faith in the doctor and/or the medicine prescribed. This faith may be regarded as a by-product of doctor-patient veracity.
To the healthcare provider, telling the truth protects the worker from legal prosecutions that result from withholding diagnostic information to the patient. According to Edwin (2008), most legal arguments in favor of hiding the truth from the patient are bound to fail in a court of law because of their contradiction to the ideology of informed consent. The fact that patients may be critically ill or emotionally vulnerable is not a good-enough reason to conceal diagnostic information from them. Neither is the justification of best interest or irrational choice adequate for invoking the privilege of the patient of being told the truth. Contrastingly, disclosing diagnostic information to the patient may prevent psychological harm since the patient that is informed of serious intervention will not be anxious or disturbed. Hence, nurses and other healthcare workers should tell the truth to the patient to avoid prosecutions since there lacks sufficient justification to support withholding of information (Edwin, 2008).
Healthcare providers find it difficult to disclose devastating diagnostic information to their ailing patients. However, they are bound by ethical, clinical, and legal obligations to be honest with their patients through disclosure of all relevant information regarding their patients’ conditions. Despite traditional paternalistic beliefs justifying withholding information from the patient, more harm than good results from such practice. The harms include loss of patient-nurse trust, lack of patients’ faith in therapeutic process by affecting their overall wellbeing, unwillingness of the patients to consult their care providers due to mistrust or lack of therapeutic relationship, and lack of necessary adjustments by the patients because of the failure to have essential information provided to them. Moreover, legal implications may result from such practice. Benefits of patient veracity to the patient include strong therapeutic relationship between the patient and the care provider and the ability of the patients to exercise autonomy by choosing an alternative treatment of their choice. Disclosure of information to the sick acts as a booster to patients’ wellbeing because of the established faith in the therapeutic process and the care provider.
Nurses and other care providers should be equipped with communication skills that help them to tackle the challenge of conveyance of diagnostic information in a compassionate, accurate, and sensitive way that does not cause more harm to the patient. This move will help in mitigating the consequences that emanate from concealment of diagnostic information by health practitioners. It will also help to build trust between the patients and the health professionals.
Drane, J., & Reich, G. (2002). Honesty in medicine: Should doctors tell the truth. American Journal of Bioethics, 2(1), 14-17.
Edwin, A. (2008). Don’t Lie but Don’t Tell the Whole Truth: The Therapeutic Privilege – Is it Ever Justified? Ghana Medical Journal, 42(4), 156–161.
Grace, P. (2009). Nursing ethics and professional responsibility in advanced practice. Boston, MA: Jones and Bartlett Publishers.
Hébert, P., Hoffmaster, B., Glass, K., & Singer, P. (2007). Bioethics for clinicians: 7. Truth telling. Canadian Medical Association Journal, 156(2), 225-228.
Punjani, N. (2013). Truth Telling to Terminally Ill Patients: To Tell or not to Tell. Journal of Clinical Research & Bioethics, 4(4), 1-2.