ch 4 bioe truth-telling and confidentiality

status of truth-telling

not a long-standing element of medical ethics

what is the modern emphasis on regarding turth-telling

autonomy, informed consent

1. against full disclosure: truth can worsen pt. condition and state of mind

counter: exaggerated harm, informed pt. = better pt., ignores damage from deception

2. against full disclosure: pt. doesn’t want to know the full truth, especially if the prognosis is grim

counter: survey data say otherwise

3. against full disclosure: physicians have no duty to disclose the full truth since pt. can’t understand

counter: communicating fully may be impossible, but conveying most essential info isn’t, conveying FULL truth is unecessary

truth-telling pros

respects autonomy for s-determ. withholding truth from pt. fails respect of autonomy, therefore truth musn’t be withheld

1. non-consequentialist arguments for confidentiality

autonomous persons have the right to privacy

2. non-consequentialist arguments for confidentiality

Dr-Pt. relationship involves implicit promise to preserve confidentiality/ respect privacy of pt., duty of fidelity

applying kantian ethics

lying = violation of C.I., prohibitions against both are absolute, appeals to consequences carry no moral weight

applying act utilitarianism

case-by-case, physician decides course of action that maximizes good for involved

applying rule utilitarianism

may argue greatest good is produced by a rule forbidding deception/breaches of confidentiality

applying virtue ethics

virtuous physicians truthfully communicate, keep promises, maintain confidences (exercise truth-telling in a way that is sensitive to its effects on pt. and empathize with desire for confidentiality)