Withholding the truth about a patient’s health, health outcomes, or treatment can be taxing for families and medical providers. Doing so could also be in direct violation of a patient’s autonomy, their right to make rational decisions and choices regarding one’s overall well-being (Vaughn, 2013, p. 71). Based on the case study provided, the decision of the doctors and patient’s family members to administer a flu shot to Mr. Simpson without his informed consent is a clear form of medical paternalism and limitation to one’s autonomy. Using the Kantian perspective about the morality of truth-telling, I claim that withholding truth or lying should never be permissible, especially in a medical setting.
Mr. Simpson, a fairly healthy eighty-year-old man with slightly weak lungs, has continuously rejected receiving an annual flu shot out of fear of contracting the flu. Although Mr. Simpson has been informed that the flu shot may help him fight off or prevent him from getting the flu, he is unwavering in his decision to not receive the shot. Because of his unwavering decision, his family has asked his doctor(s) to administer the flu shot but withhold the “truth” about the shot from the patient. Knowing that Mr. Simpson has a desire to live a long seemingly healthy life and is open to receiving treatment that will “boost his immune system”, his family has made a decision that would override Mr. Simpson’s ability to make an autonomous decision about his own health.
Despite the many attempts from his doctors, Mr. Simpson is clearly standing his ground on his decision to refuse the flu shot. Mr. Simpson, like many patients his age, may be in a stage of his life in which he feels that the flu shot would do more harm than good. He may be unwilling to express his “truth” with his family because he may not want to overwhelm them with sadness or fears about his decision. Of course, lying or withholding the truth from his family is also wrong, nevertheless, Mr. Simpson has a moral obligation to himself to be happy. Whatever consequences that arise from his decisions would be something he would have to live with or without depending on his health outcome.
Lying to patients is a clear violation of one’s autonomy. The doctors in Mr. Simpson’s case have a duty to honor his decision to refuse the flu shot even when they believe the shot would ultimately decrease his chances from catching the flu. According to Kantian ethics, “informed consent of the patient for any treatment [including the flu shot] would be mandatory and misleading the patient about the treatment would be out of the question” (Vaughn, 2013, p. 77). If the doctors choose to adhere to the family’s wishes about lying to and/or misleading Mr. Simpson and something goes wrong, the doctors would be held accountable for any negative health outcomes. In the cases of Cobbs v. Grant (1972) and Bouvia v. Superior Court (1986), courts have ruled that “competent adults have a ‘constitutionally guaranteed right’ to decide for themselves whether to submit to medical treatments” (Vaughn, 2013, p. 78). Doctors or medical providers who go against their patients right to refuse [in the absence of informed consent] are subject to actionable battery.
Not only is lying or withholding the truth from a patient morally wrong and violates his or her autonomy, asking or trying to force the doctors to lie to the patient is also in direct violation of their autonomy as well. A request of this type presumes that the medical provider isn’t capable of making a logical and/or rational decision on his or her own. This is the same as Mr. Simpson’s family trying to force him to receive the flu shot against his will. Lying, from a Kantian perspective, “is wrong because it undermines personal autonomy” (Vaughn, 2013, p. 9).
Although the argument against lying and/or withholding the truth from patients may seem like the morally obvious thing to do, there are arguments that claim that lying and/or withholding the truth should be permissible in some cases. First, one may say that Mr. Simpson is not capable of making competent decisions about his health because of his age. As individuals age, their cognitive functions typically decline. Older adults may develop Dementia, Alzheimer’s, or other cognitive disorders that limit their ability to make rational decisions concerning their health. In such cases, some would argue that medical providers and/or family members have the right or consent to withhold the truth from patients if and only if the information that’s being withheld does no harm to the patient.
While the previous argument may hold truth in some cases, Mr. Simpson’s scenario clearly states that he is in “fairly good physical health” aside from weakened lungs. There is no indication that Mr. Simpson is nonautonomous, someone who has the inability to make autonomous decisions on his or her own behalf. Regardless of an individuals age, respect for his or her autonomy should always be taken in consideration. Family members and medical providers have a moral obligation to respect and respond to the needs of patients as they arise. In other words, “individuals should do unto others as they would have them do unto them”.
Another argument that can be possibly made for lying and/or withholding the truth from patients is that telling the truth could possibly do more harm than good. Some providers may lie or withhold the truth about a patient’s illness/condition in hopes of the patient getting better. According to Vaughn (2013), it was once speculated that patients with serious/terminal illness benefited from their provider withholding the truth about their condition. Withholding the truth or lying in this case would have been considered justifiable because the provider would have been “protecting” or “shielding” the patient from anxiety or worry about his or her condition (p. 154).
Granting the previous argument is plausible, trying to “protect” or “shield” patients from anxiety or worry still does not give providers the right to override one’s ability to make rational decisions about his or her care. In fact, according to Kant, “the act of lying [can possibly] cause injury”…For [a lie] always injures another; if not another individual, yet mankind generally, since it vitiates the source of justice” (Kant, 1909, as cited in Vaughn 2013, p. 147). In other words, there should never be a reason for anyone to lie or withhold the truth, regardless of the situation or outcome. Individuals, especially medical providers, have a moral duty to honest, open, and transparent about a patient’s health whether positive or negative.
Lying should always be proceeded with a level of caution and concern in all aspects of one’s life especially in a medical setting. A lie can diminish any type of trust, rapport, and/or credibility that a patient relies on when seeking medical advice or guidance. If medical providers accept lying as an acceptable way of overriding a patient’s decisions, informed consent should become a thing of the past. Withholding the truth or lying in a medical setting should be avoided if possible and without judgement. Any instances in which medical providers refuse to fully inform their patients of treatment should be questioned because a patient’s life and personal decisions are more important than those of the doctor or the patient’s family. Based on the arguments against and for lying or withholding the truth from patients, it can be concluded that an individual’s right to decide is more important than the decisions of medical providers and family members. Although the patient expresses the desire to live, it is ultimately his choice to refuse getting the flu shot regardless of the benefits he has been made aware of. Therefore, in Mr. Simpson’s case, doctors should adhere to the patient’s decision to refuse the flu shot because it would be the most ethical and morally right thing to do.