Home 
Contact 
Profile 
Videos 
Presentation at a training program for family
medicine resident s at the National Guard Madina 9-10 November 2014 by
Professor Omar Hasan Kasule Sr. MB ChB (MUK). M{H (Harvard), DrPH (Harvard)
Chairman of the Ethics Committee King Fahad Medical City.
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.
WHAT IS
DISCLOSED
·
Disclosure of some forms of
information may constitute malefacence.
·
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
1
·
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 of 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.
GIVING BAD NEWS 1
·
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.
GIVING BAD NEWS 2
·
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.