Idara C. Eshiet

 Mr. Z, a 70 year- old Cantonese – speaking man, with a change in bowel habits and weight loss is found to have Colon cancer. The daughter and son ask the physician not to tell their father that he has cancer. They say that people in his generation are not told they have cancer and that if Mr. Z is told he will lose hope.

Lying- this refers to statements that the speaker knows are false or believes to be false and that are intended to mislead the listener. Deception- it is broader than lying, and includes all statements and actions that are intended to mislead the listener, whether or not they are literally true. E.g. telling the patient that he has a “growth”, hoping that the patient would believe nothing is wrong.

Misrepresentation- is still a broader category, including unintentional, as well as intentional statements and actions. This statements might be true or untrue. Misrepresentation could be intentional or unintentional. Nondisclosure- This means that the physician does not provide information about the diagnosis, prognosis, or plan of care.

a. It prevents serious harm to patients b. It is culturally appropriate c. It may enhance patient autonomy d. There are no less problematic alternatives

 It shows disrespect for patients  Most patients want to know their diagnosis and options for care  Patients need information for decisions  Disclosure has more beneficial than harmful consequences  It requires more deception  It might be impossible

1. If the physician has a compelling evidence that disclosure will cause real and predictable harm. E.g. Disclosure would make a depressed patient actively suicidal then it would be justified to withhold the diagnosis while obtaining psychiatric evaluation. 2. If the patient him or herself states an informed preference not to be told the truth.

 Anticipate Dilemmas  Determine what the patient wants  Elicit the family’s concerns- finding alternatives The physician should validate the family’s feelings as the natural reactions of loving relatives.  Focus on how to tell the diagnosis, not whether to tell- explain to the family how disclosure of bad news can be done in supportive ways that help patients cope.

Physicians should soften bad news by being compassionate, responding to the patient’s concerns, offering empathy and helping mobilize support.  If you are withholding information, then plan for future contingencies.  Maintain Transparency and Accountability  Respect patient’s preferences

 Mr. Z, a 70 year- old Cantonese – speaking man, with a change in bowel habits and weight loss is found to have Colon cancer. The daughter and son ask the physician not to tell their father that he has cancer. They say that people in his generation are not told they have cancer and that if Mr. Z is told he will lose hope.

For the case above, what is the most appropriate response? a. “ what do you fear most about telling your father he has cancer? b. “ I have to tell your father of the diagnosis” c. “ since you all agree about not telling your father, I won’t tell him” d. “ my not telling your father his diagnosis might present it’s own problems”

A patient asks a physician to sign a form excusing an absence from work. He says that he had a severe upper respiratory infection, but has now recovered. The physician did not see the patient while he was ill.

 Consider whether an important health benefit is at stake – you need to ask in what sense you are helping the patient  Deception might not be necessary- The strategy of using the literal truth is appropriate if it is not deceptive and prevents harm to the patient.  Exhaust other alternatives  Involve patients who request deception

The deceptive use of placebos is not ethically justifiable. Specific exceptions should be rare and only considered when the following conditions are met: a. The condition is known to have a high placebo response rate. b. The alternatives are ineffective and / or risky.

A 65-year-old man comes to his physician with complaints of abdominal pain that is persistent but not extreme. Workup reveals that he has metastatic cancer of the pancreas. The man has just retired from a busy professional career, and he and his wife are about to leave on a round-the-world cruise that they've been planning for over a year. Should you tell him his diagnosis?