LIES TO THE SICK AND

DYING
By: Collin Vause
&
Margaret Gilligan

Introduction

Deception as a Therapy

Lying as Result of Doctors Uncertainty

Dilemmas with Doctors Uncertainty

Doctors Perspective vs. Patients Perspective

3 Major Arguments Lying is Good

Reasons Against the Arguments

Respectful and Truthfulness

Deception as a Therapy

Doctors are confronted with daily problems that

need immediate decisions when it comes to sick
and dying patients: what to reveal, what to hold
back, or what to distort, will matter profoundly to
patients
Used as a therapeutic regiment
The Freedom to Lie = become an excusable act as long as doctors are not breaking the law,
they are given the liberty of how much or how
little to tell the patient
Lying is usually wrong, but less so when telling
the truth is harmful.

B. C. Meyer

Ours is a profession which traditionally

has been guided by a perception that
transcends the virtue of uttering truth for
truths sake, and that is, so far as
possible, do no harm.- Meyer

Telling the truth is a crucial for all doctors

to uphold, but not when it puts the health
and the well-being of the patient in
jeopardy.

Deception as a Therapy Cont.

Used by doctors as a means of helping

patients stay hopeful, and even stay alive
Doctors use their knowledge and expertise
to make deceptive decisions
ONLY doctors should use tactics of
manipulating the truth, depending on each
individual patients needs
2 fundamental principles: doing good & not
doing harm beneficence & nonmaleficence
imperative for all health professionals

Deception as a Therapy
Cont.

All oaths, code and prayers in the history of

medicine, make no mention of being truthful

The ultimate task in the medical profession:

to preserve life and good health, and to ward
off illness, pain, and death.

From the Hippocratic Oath, in the late 5 th century, to

1948 Declaration of Geneva, adopted by the World
Medical Association, no mention of truthfulness

Doctors Uncertainty

To avoid misdiagnosis - different diseases and

illnesses have similar symptoms
Uncertainty and fears revealed to the patient
can reduce the patients faith in recovery
Doctors fear revealing grave risks, no matter
how small, will become self-fulfilling
prophecy.
Hate being bearers of bad news
Time consuming takes time to explain critical
illnesses or possible death situations - time is
needed with other patients equally important

Dilemmas with Doctors

Uncertainty

Doctors dont work alone other doctors

and nurses are also involved in patients
care
Decision to lie is not universal
If one doesnt agree, he/she now has to
play a part they dont think is right or
humane
Different doctors respond differently in
same situations
Relatives of sick and dying patients may
disagree in how and when to tell patients

Doctors Perspective
vs.
Patients Perspective

1) Being Truthful is impossible

2) Patients do not want to hear bad news

3) Truthful information could be harmful

1) Being Truthful is Impossible

Where a person would typically understand

what they were being told, doctors believe
sick patients are often not in a position to
do so
Not in the right mindset to understand the
truth or the gravity of the situation
Not in the right mind set to make health
decisions for themselves, especially if the
decision needs to be made immediately
This gives the doctor the freedom to
determine WHAT to tell the patient, and
HOW to say it

Problems

Most patients still have the ability to make correct

decisions concerning their health
If the patient does not believe they have the
competence to understand the information being
given, they have the right to choose a family
member or close relative to receive the
information for them
Problem with Paternalism a person, lying to
another for the good of that person this suggests
that the doctor takes on a superior role over the
patient, and can lead to contempt between them
Even the best doctors can be wrong, and can
make decisions the patients would want differently

2) Patients do NOT want to hear

bad news

It means exactly what it says!

Doctors say patients do not want to hear bad
news, especially if that news is of a serious,
frightening or depressing nature, and death is a
possibility
Requires the patient to now face their illness and
even soon death
Surveys have shown many doctors in this
situation would NOT inform their patient of the
severity of their illness, even if they had cancer
In the doctors eyes, the more a patient asks to
know.the more fear he experiences.which
leads to denial of ones condition, especially in
the face of death

Problems

Studies show 80% of patients would like to

know if their condition was life-threatening,
especially something as serious as cancer
15-25% of patients show signs of denial after
hearing bad news, but there is no way to
prove each patient experiences denial
Some want to be deceived of their illness,
and others go into denial and reject the bad
news.
Still others want to know the whole truth

Elizabeth Kubler-Ross

Studied near-death situations in patients,

her 1969 book On Death and Dying,
discusses 5 stages of grief: denial, anger,
bargaining, depression, and acceptance.
Elizabeth Kubler-Ross said denial comes
from premature and abrupt information
being given to a patient from a stranger

More Problems

Doctors think they are being charitable by

lying
However, if patients do NOT know the
severity of the situation, they might agree to
a surgery, blood transfusions, respirators or
even resuscitations, and be simply
prolonging their death unknowingly
Believed the fear patients have in dying or
being dead is due to lack of trust dying
patients have in their health providers
Sense of trust is gone with so many
strangers attending to them

3) Truthful Information Could Be

Harmful

Bad news could trigger suicide attempts,

cardiac arrest, or prevent them from
having hope of recovery
Rejection of vaccinations and necessary
medications
Stop fighting to live or recover

Problems

Challenged from 2 different view points:

1) Damages from knowing the truth is more rare
than doctors think
2) Benefits from the patient knowing the whole truth
are significant

What you dont know, wont hurt your

slowly being proved wrong; not knowing is
causing patients to worry more
No conclusive facts to say this is the same for
all patients
Physicians still fear full knowledge will cause
suicide attempts, heighten fear and depression

Suicide or Dying Response

Suicide: could be best decision in the

situation
No longer completely frowned upon
Other societies allow it, and now the U.S. too
Distinctions between which suicides to respect,
and which ones to prevent

Dying Response: natural and accepting

Surrounded by friends, family, and loved ones
Reminiscing about life
Pardoning and forgiving
Final prayers, and asking for Gods blessing on all

Truth

We are still learning more and more

everyday about the benefits of telling the
TRUTH to patients

http://www.medscape.com/viewarticle/
804885

Respect and Truthfulness

Narrow, paternalistic views have been set

What is right for one person, is not for another
SOME patients do not understand, SOME do not
want to know, and SOME can be harmed
Few request to be deceived
Some give off signals they are not able to
handle shock or bad news well
In this case, concealing or withholding
information from the patient is necessary, but
needs to have clear and concise reasons why!

Views from Laws

Perspective

The law permits withholding of

information where the truth will hurt the
patient
Lying for the good of the patient
However, this phrase will NOT hold in a
court of law too broad of a topic
Can lead to doctors, nurses and other
care takers to be sued

Openness, Trust & Hope

Goal of doctor-patient relationship = to

have a trusting and open relationship, in
both personal and medical aspect
Truthfulness does not mean no hope
Using lying and deception to sick and
dying patients needs to be well thought
out, and all options considered for the
best care of each patient

Options for Patients

Informed Consent requires all

information to be disclosed to the patient,
no matter how risky
Living Wills patients specify their wishes

More and more sick and dying patients are

signing living wills to include which types of
information they wish to be disclosed to them

Needing Care vs. Providing Care

Very important for those providing care, put

themselves in the shoes of the one needing care
For doctors, putting themselves in the patients
positions might make them think more about the
decisions they make
For patients, they need to respect the expertise
of the doctor, and provide as much information
as possible to help his/her decision making
Reason why communication is so important for
both the doctor and the patient, even in death
and dying situations

Class Exercise

A) Answer YES or NO for the questions on

the last page of your handout
B) Brief discussion of our answers

Thank you for your participation!

References

Bok, Sissela.Lies To the Sick and Dying. Lying:

Moral Choice in Public and Private Life (New York'
Pantheon. 1978)
http://www.businessballs.com/elisabeth_kubler_ross_
five_stages_of_grief.htm

Caplan, A.L., PhD, Tell a Patient, Youre Terminal - Yes or No. Medscape Business of Medicine. May 31,
2013.
file:///Users/margaretgilligan/Desktop/Lies%20
to%20the%20Sick%20and%20Dying/Vedio%20for%20Si
ck%20and%20Dying%20Pres.html

http://www.bmj.com/content/346/bmj.f2560?tab=met
rics