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Presentation to the Muslim Health
Professionals Ramadhan Seminar Mombasa August 3, 2013 by Professor Omar Hasan
Kasule Sr. MB ChB (MUK), MPH (Harvard), DrPH (Harvard)
OBLIGATION TO
TELL THE TRUTH
As part of the
professional contract between the physician and the patient, the physician must
tell the whole truth. Veracity is based on respect for autonomy, fidelity, and
confidentiality. Patients have the right to know the risks and benefits of
medical procedure in order for them to make an autonomous informed consent.
Deception violates fidelity.
The principle of
veracity is derived from
WHAT IS
DISCLOSED
Disclosure of some
forms of information may constitute malfeasance. There is no obligation to
disclose information that the patient does not request or does not want. Some
patients may prefer not to know the truth. There is no obligation to disclose
unwanted information. Patients should be told only what they need to know or
what they want to know.
PARTIAL
DISCLOSURE and WHITE or TECHNICAL LIES
Partial disclosure
can be considered a half truth and therefore a form of lying. Technical lies
are statements that are apparently true and whose truth can be defended using
data and reasoning but they contain an element of untruth that any person privy
to the whole information will be able to discern. The physician may consider
telling ‘white lies’ for the sake of the patient welfare. The physician should
be guided in his communication by the background and understanding of a patient.
Some patients can be given a lot of information and they do not get disturbed.
Some types of information agitate patients. The prophet taught talking to each
person according to his ability to understand.
DISCLOSURES TO
OTHERS ABOUT THE PATIENT
It may be necessary
that the physician shares some confidential information with members of the
family in order to get involve them in patient care. This may take the form of
getting more information about the patient, consultation about the best care or
trying to interpret and understand the patient’s choices and decisions. In
general divulging unsolicited information to governmental or other authorities
is frowned upon.
GIVING BAD NEWS
Bad news is common in medicine. The patient
may have to be told about a diagnostic result that indicates a more serious
disease than had been anticipated. The prognosis may be bad or the treatment
may fail. In general it is better to keep quiet than to pronounce anything that
is uncomfortable. However the obligation or veracity and transparency force the
physician to give bad news to the patient and the family.
Telling the patient half truths or white
technical lies may be a way out of the dilemma of giving bad news but it
destroys the confidence and trust that patients put in doctors. Telling a
straight lie is forbidden. Each case should be evaluated on its own merits by
balancing benefits and injuries. In the end it may be better to be straight in
dealing with the patient and warn them before giving bad news. Their permission
could also be asked. Some may prefer that they be not told the whole truth
because that would distress and disturb them.
Some bad news is better given to the
relatives. They can find a way of conveying the information in a gentler way
that minimizes the mental injury to the patient. They may also make a better
judgment of what to tell and what not to tell the patient.
Some bad news may
be given to authorities in the form of medical certification for temporary or
permanent disability, sick leave, and return to work.
Physicians should be careful
about their body language. It is very difficult to hide feelings inside. The
patient will read the body language and will believe it more than verbal
language. A verbal reassurance of the patient that he will so well can be
contradicted by show of worry and agitation on the face of the physician. This
is perhaps one argument for telling the whole truth to the patient whatever the
consequence because they can read it for themselves from the physician’s body
language.