Ethical dilemmas routinely occur in people’s lives. Individuals constantly face hard times contemplating available options before selecting the supposedly right choice or course of action. Such dilemmas are also present in the medical field and can sometimes turn the lives of doctors and patients upside down. Mr. Purplepatch and his patient, Mrs. Blank, are facing one hard situation that requires them to select one of the two available hard options. Should they rely on the results of the test with a 95% accuracy and undergo a hazardous treatment or hope that the 5% remaining would save the life of Mrs. Blank? Should the doctor be transparent in this case? This paper intends to analyze the possible options that the doctor has by deeply examining them and selecting the best course of action.
Lies in the doctor-patient relationship are commonly found, especially in the cases of severely ill patients. Doctors often justify such actions by stating that those patients are better off not knowing the absolute truth. At the same time, many doctors and psychologists believe that honesty is a central aspect of the relationship between the doctor and his patient and a major feature for severely ill patients.
In an article published in the Journal of Medical Ethics in 1982, this concern was intensely discussed. Dr. Lawrence Goldie, who specializes in psychotherapy for dying and severely ill patients, aims to convince people about the importance of complete honesty in medicine, especially for people risking death. First of all, three arguments against truth-telling were presented and then refuted by Dr. Goldie. The first is that doctors’ main objective is the well-being of their patients who already are suffering a lot, therefore telling them that they’re in a very delicate situation and might die would only cause additional complications for them. The second argument is that doctors can never be 100% sure of the diagnosis and should therefore remain quiet. The third argument is that patients themselves would not want to be told the truth when they reach the stage of an incurable and deadly disease. Dr. Lawrence Goldie starts by counter-proving the first argument. He claims that truth-telling’s benefits outweigh its harm. Dr. Goldie understands the anguish caused when revealing the truth but argues that when an ill patient knows that he’s dying, he would try so hard to spend his remaining time doing the things that he likes, spending time with the people he loves, arranging affairs with the people he once loved and improving the process of dying as much as possible. The second counterargument is that doctors should transmit all known information to their patients even if the information may not be 100% true. At the end of the day, nothing is perfect in the world and patients should know about any situation that they may have to face someday in the future. The last counterargument is experimental: a survey showed that severely ill people would actually like to know the truth rather than being lied to by their doctors. This fact is opposed to the misbelief that says that patients do not wish to be told the truth about their fatal condition.
Linking those counterarguments to the situation faced by Dr. Purplepatch and Mrs. Blank, the doctor seems to have accomplished his first duty successfully by explaining the situation carefully to his patient. As dramatic as it sounds, Dr. Purplepatch clarified everything and told his patient about the two possible routes that may be taken along with the outcomes of each one. His second duty falls in the advice that should be given afterward: should he just recommend an option or force one by claiming that it would be the only one to surely save her? Doing so would be considered lying since both processes don’t assure the survival of Mrs. Blank. Well, according to Dr. Lawrence Goldie, honesty between both sides should always be present. Therefore, Dr. Purplepatch should tell his patient that no ideal course of action exists and that choosing either way would create some risk. Consequently, Dr. Purplepatch should advise to move forward with the least risky procedure. Based on the 95% accuracy of the test and using the arguments stated above, Dr. Purplepatch should advise Mrs. Blank to undergo the treatment and should also let her know that the treatment doesn’t guarantee her a completely healthy life because of the potential removal of her kidneys and liver. By doing so, the patient’s autonomy would be respected and the doctor would have completed all of his obligations.
On the other hand, Plato once said: « le mensonge est condamnable sauf en medecine » as in lying is condemnable except in medicine. For Plato, as for many other people, doctors are the only individuals in the world who have the right to lie to their patients. This idea is based on the fact that lying to severely ill patients in certain circumstances can sometimes be beneficial.
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In 2014, Dr. Sandeep Jauhar published an article in the New York Times entitled: “When doctors need to lie” in which he, as the title shows, justifies the act of lying in medicine in specific situations. He also doesn’t deny the fact that patients’ autonomy should be the priority in normal cases. According to Dr. Jauhar, the underlying philosophy in cases of lying is paternalism: The physician must do no harm to his patients and always look for their welfare, as the father to his children. Using this as a reference point, Dr. Jauhar believes that while doctors may not want to lie to their patients, they sometimes do it for their well-being. He gives the example of a situation that happened once with a patient of his, a 22-year-old Jamaican man. This man was suffering from severe heart problems and probably needed a heart transplant. After telling him about his situation, the Jamaican man was devastated and started crying. At this specific point, Dr. Jauhar knew that doctors sometimes should keep secrets.
Relating this to the dilemma faced by Dr. Purplepatch and Mrs. Blank, it would seem that the doctor already made an error in revealing the absolute truth to his patient all at once. Indeed, Mrs. Blank seems confused and lost. She was already dealing with the physical pain and she’ll have to deal with the emotional pain after knowing that her life is on the line. Dr. Purplepatch’s objective now should be to find what’s best for his patient both on the physical and emotional side. He’s supposed to try hard to reduce the agony that he caused when he told her the absolute truth. Lying now become an option. In fact, Dr. Purplepatch should select the appropriate procedure and persuade Mrs. Blank that this procedure would be the only one to eventually save her life. Implementing this strategy would diminish the already-triggered anguish and would give the patient some hope, even though the selected procedure could lead to the patient’s death. Supposing that Purplepatch selects the course of treatment, he would then have to somehow convince his patient that the treatment is the only way that would guarantee her life.
In such delicate dilemmas, different points of view will be present. Some people may think that Dr.Purplepatch should lie, other are convinced that telling the truth is always the first phase of reaching the optimal solution. Some people may also believe that Dr. Purplepatch should persuade Mrs. Blank to undergo the hazardous treatment even if it includes removing the liver and kidneys. Others consider that such a dangerous treatment might cause additional health problems and that the patient should hope that the test is wrong, rely on the 5%, and undergo the course of non-treatment.
Personally, I believe that lying can never be justifiable. And in this specific case, lying can even be considered disrespectful. I’m not saying that lying to patients in difficult situations isn’t usually done with the intention of avoiding hurting the patients, but it would be an underestimation of the patient’s ability to overcome tough situations. As discussed above, a survey showed that severely ill patients would actually want to know everything about their situation. They might want to plan something for their families before leaving them for example. In addition, trust between the patient and his doctor would be completely lost the moment the doctor decides to lie. In addition, lying now becomes much harder since patients can access information related to their condition on the Internet. For these reasons I believe that Dr. Purplepatch did the right thing by being completely transparent and honest with his patient, telling her everything about her situation.
In regards to the advice that has to be given by Dr.Purplepatch, undergoing the course of treatment should be recommended. Studies show that no test or treatment in the world gives 100% accuracy. In fact, according to Dr. Trisha Torrey (2018), the majority of medical tests are not 100% reliable, but at the same time, it’s well known that every test that is conducted in hospitals usually follows a detailed protocol before being used legally on human beings. Such a protocol makes sure that the test is as reliable as possible and can be used and trusted by individuals, but will never reach an accuracy of 100%. Therefore, a 95% accuracy on the test conducted can be considered high and should convince both the patient and the doctor that the ethical thing to do would be to undergo the treatment. On the other hand, Mrs. Blank may ask herself the following question: if there’s a 5% chance that the test is wrong and that she isn’t actually affected by the Witheringspoon-X deadly disease, why would she start such a hazardous treatment that might require the removal of her kidneys and liver. The answer here is simple: relying on a probability of only 5% is even riskier than undergoing a dangerous treatment. The issue that is discussed here is the life of a woman and not a game of chance. Indeed, in games of chance like poker, the worst that can happen is the loss of money, while here the life of a woman is on the line. The doctor should therefore select the procedure that assures his patient the highest probability of success, even if that probability doesn’t reach 100%. Therefore, in this specific case, the course of treatment should be recommended. At the same time, the doctor should be completely transparent and remind his patient that this process enhances her chances but doesn’t guarantee her survival. Furthermore, this is the life of Mrs. Blank, not the doctor’s, and she should be the one making the final decision regarding the process selection while taking into consideration her doctor’s advice.
On the whole, making life-changing decisions is a very hard task. Doctors usually spend some hard time contemplating the available possibilities especially when the lives of their patients are on the line. Should they lie or not? Should they just recommend a process or persuade their patients to select that process? All these questions are serious ones faced by a vast number of doctors around the world including Dr. Purplepatch. This paper has shown why honesty should always be a priority between doctors and patients, and why doctors’ main goal should always be to maximize the risk of success when their patients are in danger. Dr. Purplepatch was completely honest and performed, up to the point, all his duties perfectly. The only thing he still has to do is to recommend the course of treatment to Mrs. Blank and to explain to her why this available possibility enhances her chance of survival. Nonetheless, the last call should be Mrs. Blank’s. She’s the one who will make the final and last decision. However, is she in a position where she has the ability to do that?
Sources
- Sandeep Jauhar (2014). “When doctors need to lie”. The New York Times. Retrieved from https://www.nytimes.com/2014/02/23/opinion/sunday/when-doctors-need-to-lie.html
- “On telling dying patients the truth” (1982, September). Journal of medical ethics. Retrieved from https://www.jstor.org/stable/27716063
- Trisha Torrey (2018). “How accurate are your medical tests?”. Very well health. Retrieved from https://www.verywellhealth.com/how-accurate-are-your-medical-test-results-2615480
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