Wednesday, August 2, 2017

Truth-telling and Disclosure In Medicine

Five years ago, a dear friend passed on. I did not even know she was sick. She was only 46 years old and stayed for a month and a half at the intensive care unit because of post-operative complications. She underwent major abdominal surgery after she was diagnosed with a malignant growth in her stomach. The surgery took 11 hours to finish. A few hours post-op, she developed respiratory failure and subsequently, an infection. She was placed on life support and she did improve. Unfortunately, her immune system failed and she developed more infections. The question on many people's mind including mine was, what happened? I asked some surgeon friends what their opinion was and most said that since the cancer seemed localized, meaning there was no spread beyond her stomach and esophagus, a resection was the right thing to do. She was young and a fairly good surgical risk so that there was a good chance for a cure. But she died. And her family, friends and acquaintances do not understand why. Many have started to speculate. Although I have not heard her family say anything derogatory but one friend even dared to say that the doctors "experimented" on her. An unfair statement but understandable under the circumstances because from the conversations during the wake, it appears that the family were at a loss of what transpired during the 11 hours of operation. It is no wonder then that people are making guesses and conclusions about her death.
The Role of Truth-telling and Disclosure

Truth-telling in the practice of medicine requires the giving of information that will apprise patients about their current health situation and therefore, help them make informed decisions about their medical and health care. The information should be given in such a way that it can be understood and used to make a decision. Truth-telling is the duty of the physician and it enhances trust. The pateint has the right to know.

But what if the patient does not want to know or the family does not want their patient to know? Withholding information may be justifed only in certain instances.

Lying in a clinical context is wrong for many reasons but less than the total truth may be morally justifiable in the following situations:
–If a patient is depressed and irrational and suicidal, then caution is required lest full truth contribute to grave harm.
–If a patient is overly pessimistic, informing him of negative possibilities may actually contribute to actualizing these very possibilities.

The question, I believe should not be IF, but HOW. As Health professionals we should learn how to attend to patient's and parent's cues, know how to break bad news, have a clear plan. Empathy plays a very important role in truth telling and disclosure. To hear, to see, and to feel what our patients (and parents) hear, see and feel.

No comments:

Post a Comment

Thank you for your comments.