Is It Ever Ethical to Lie to a Patient? Samuel Knapp, Ed.D., ABPP Director of Professional Affairs John ava!!i, Ps".D.

, ABPP PPA Ethics #ommittee All of us have $een tau%ht to spea& honestl" and refrain from l"in%. 'onest" is part of $uildin% trust in a relationship, althou%h it can $e important to temper honest" (ith courtes" and tactfulness. 'o(ever, is it ever ethical to lie to a patient? Are there certain circumstances in (hich a ps"cholo%ist ma" consider $ein% deceitful (ith patients? If so, ho( does this $ehavior s)uare (ith our personal values and professional ethics? #onsider this situation* Dr. Doe receives a phone call from a prospective patient and )uic&l" identifies her as the (oman (ho is havin% an affair (ith the hus$and of one of his current patients. Dr. Doe has an openin% and e+pertise in the area of concern for this prospective patient. 'o(ever, Dr. Doe (ants to avoid the difficulties that (ould occur if he (ere to treat this patient. ,rdinaril", Dr. Doe (ould simpl" tell the patient he did not thin& he (ould $e the $est fit for her and refer her to another hi%hl" competent practitioner in the communit". 'o(ever, this prospective patient had alread" mentioned, in their $rief phone conversation, that she &ne( he listed relationship issues as one of his areas of proficienc" on his (e$site. -hat is the solution to this dilemma? Dr. Doe &ne( of one situation (here another ps"cholo%ist accepted a patient into therap", onl" to learn that there (ere e+treme conflicts $et(een her and another e+istin% patient. In that case, the ps"cholo%ist did not learn of the relationship pro$lems until $oth patients (ere (ell into therap" and the ps"cholo%ist $elieved

that terminatin% one or $oth of them (ould cause more harm than $enefit. 'o(ever, this ps"cholo%ist had to monitor her (ords carefull" to ensure she did not allo( information o$tained from one patient to slip into the conversation (hen dealin% (ith the other patient. Also, the ps"cholo%ist had to ma&e sure she scheduled the patients on different da"s so the" did not encounter each other in the (aitin% room. Dr. Doe reflected on another situation in (hich a ps"cholo%ist found out, (ell into the course of therap", that she (as treatin% the hated sister.in.la( of one of her current patients. Because the hated sister.in.la( (as nearl" finished (ith therap", the ps"cholo%ist decided to see her for a fe( more sessions until therap" (ould end naturall". 'o(ever, one patient came into the office to reschedule an appointment and ran into the other in the (aitin% room. /he result (as not %ood. Both patients felt $etra"ed. ,ne patient dropped out of treatment. /hese outcomes (ere on Dr. Doe0s mind as she (ei%hed her decisions. -hat options does she have? Dr. Doe could simpl" %ive the patient a va%ue statement li&e 1there is a conflict of interest that prohi$its me from (or&in% (ith "ou.2 /his va%ue e+planation has the advanta%e of maintainin% honest" on the part of ps"cholo%ist. 'o(ever, it mi%ht confuse or upset the prospective patient. 3urthermore, the patient mi%ht infer the nature of the conflict of interest and the ps"cholo%ist (ould indirectl" $e tellin% her that her nemesis (as in therap" (ith Dr. Doe. Should Dr. Doe lie and sa" that $ecause of schedulin% purposes she (as onl" ta&in% a ver" fe( short.time patients and therefore could not see her? It has the advanta%e of sparin% the feelin%s of the prospective patient and protectin% his current patient. 'o(ever, it is still a lie. #onsider another situation* Dr. Jones did an inta&e on a patient (ho (as ver" concerned her patient mi%ht die from suicide. /his man came from a ver" impoverished $ac&%round and too&

pride in the fact that he (as a$le to pa" his de$ts and live independentl", althou%h he (as currentl" stru%%lin% financiall" and (ould pro$a$l" drop out of therap" if he had to pa" for it. 4n$e&no(nst to the patient, his insurance (ould not cover most of his mental health costs. After the second session, the patient as&ed if the insurance covered the services and if he o(ed an"thin%. If Dr. Jones told the truth a$out the insurance, it mi%ht increase the li&elihood of the patient droppin% out of therap", and increase the li&elihood that the patient mi%ht attempt suicide. Althou%h Dr. Jones mi%ht tr" to persuade the patient to sta" in therap" as a pro $ono patient, it is unli&el" that the patient (ould accept that arran%ement and (ould li&el" feel ver" offended. . Is it ethical for Dr. Jones to lie and sa" that nothin% (as o(ed? In this situation, Dr. Jones said that his insurance (as prett" %ood and if Dr. Jones thou%ht there (ere an" pro$lems (ith pa"ment, she (ould let him &no( promptl". Dr. Jones told herself that (hat she said (as technicall" accurate $ecause she used the phrase 1if I thou%ht there (ere an" pro$lems. . .2 -hile technicall" correct, the ps"cholo%ist clearl" deceived the patient. -as Dr. Jones $ein% ethical? If Dr. Jones lied after the second session and treatment continued, (ould she cause more harm if the patient later found out that Dr. Jones had $een l"in% to him throu%hout treatment? /here ma" $e other situations (here a ps"cholo%ist ma" contemplate deceivin% a patient for $eneficent reasons. If "ou (ere Dr. Doe, (ould "ou lie to the prospective patient a$out "our schedule? If "ou (ere Dr. Jones, (ould "ou tell the truth a$out the limited covera%e under his insurance polic"? 'o( (ould "ou feel a$out en%a%in% in such $ehaviors? /he %oal of this article is to prompt ps"cholo%ists to reflect on $oth personal values and professional ethics especiall" (hen dilemmas have no eas" or 1correct2 ans(er.