A. What does Thomasma mean by his contention that truth-telling is a right, a utility, and a kindness? (10 points)
B. Is Thomasma’s view a form of strong paternalism? Why or why not? (5 points)
What point does he make by citing the case of ambiguous genitalia? (5 points)
A. According to Lipkin, why is it usually impossible to tell patients the whole truth? (5 points)
B. What is Lipkin’s crucial test for determining the appropriate degree of honesty to use with patients? (5 points)
C. What does he say about the charge that doctors are too authoritarian? (5 points)
A. Would Kant endorse a paternalistic view of truth-telling to patients? Why or why not? (10 points)
B. According to Kant, how does a lie always cause injury? (5 points)
C. How would his policy toward truth-telling differ from that of a consequentialist? (5 points)
A. How do Cullen and Klein respond to those who claim it is impossible to tell patients the truth? (5 points)
B. What is the “default position” for physicians? (5 points)
C. According to Cullen and Klein, when is it permissible for doctors to deceive a patient? (5 points)
A. What were the results of Siegler’s informal survey to determine the number of people who had access to his patient’s hospital record? (5 points)
Does he favor giving up attempts to preserve confidentiality? (5 points)
What possible solutions does Siegler offer for preserving confidentiality in today’s health care systems? (5 points)
A. According to Macklin, how could tolerance of the beliefs and practices of other cultures lead physicians to harm patients? (5 points)
Does Macklin advocate intolerance toward other cultures? Explain. (5 points)
According to Macklin, how can tolerance of other cultures cause physicians to violate patient autonomy? (5 points)
1A. Lying is an act of deception. It is used as a weapon that strays away from the truth. In medicine, there are ethical issues that arise in which truth-telling is put in jeopardy. Thomasma aims to argue that truth-telling is a right, a utility, and a kindness. He highlights the fact that truth-telling is a moral rule. He argues that Truth-telling is an inherent right because it expresses the respect you hold for the person that should own the truth. Without this respect, a person is deceived and is uninformed of their reality. As developing persons, we are taught to tell the truth. With that being said, our relationships our held together knowing that one can trust the other to be honest and tell the truth. Truth-telling is a moral rule that is needed in order to keep any society afloat and be able to trust one another. In medicine, the patient has the right to know their medical condition and make decisions based on the true information. Thomasma then argues that truth-telling is a utility. In order to make an informed decision, one needs to know the truth. If someone is deceived and not told the full truth or told a lie, they are unable to make a decision based on what is the actual truth. In medicine, the patient deserves the right to know their diagnosis. The patients have a right to their autonomy, and making decisions to withhold medical information from them is wrong because without full disclosure of their diagnosis their medical decisions may be skewed. Lastly, Thomasma argues that truth-telling is a kindness. When one begins to lie, it not only hurts the person they deceive, but it also serves as poison to the liar. Lying keeps information from another that they deserve to know. The liar is harming their relationship and not acting in a kind manner because people want to know the truth. All in all, Thomasma explains why truth-telling is a right, a utility, and a kindness because it gives the other full access to what they should know.
1B. Paternalism is the act of speaking for another when one is not able to make a rational decision. Thomasma has a strong paternalistic view in medicine because he believes that values that pertain to the quality of life trump the act of telling the truth. He argues that the most important thing to consider is the survival of the individual and the community surrounding the patient, and then the consideration of the moral rule. For example, in his article he explains that if a person obtains a terminal illness, withholding the truth may be vital to contain their current quality of life. If revealed they may withdraw and check out from society in efforts to cope with the inevitable. Speaking for and making the decision to withhold this information is acting in a paternalistic manner. Thomasma describes that at the diagnosis of a terminal illness, it is not necessary to reveal reality and the truth. He constructs that as the patient get sicker, the patient can gradually learn and begin to accept death before those who would be in denial and the family are told the truth. Thomasma believes that one should act in accordance with the betterment of the patient.
1C. The ambiguous genitalia case aims to show that in some medical cases the truth, as bad as it may be, is required to be told. The woman was not born a woman, as biology would indicate. Although she identifies as a woman, she has an undescended testicle, which biologically indicates her as a male. In this instance, medicine trumps the ability to withhold medical information from her as surgery is needed. It is an interesting example to consider ethically if national standards were not in place and surgery was not required. As a medical doctor, do you destroy a woman’s idea of the gender believed she identified with? The ethics behind telling the patient, disregarding national standards, are complex and could destroy the identity of this woman because everything she has grown up to be is her false reality. In regards to the condition, the physician is obligated to inform this patient and is denied the ability to deceive in order to protect the patient.
2A. Lipkin aims to argue it is impossible to tell the whole truth because in most cases it does more harm then good. Patients are receiving medical attention because there is a problem with the functioning of their body. In a time of panic, the mind singles out and emphasizes words that were not meant in that dramatic sense. Patients often interpret the doctor’s words differently than the doctor’s intention. To explain, medical diagnoses and medical terms have become words that are a part of common language, but these terms are not fully understood to the common folk. Patients base their belief of knowledge on diagnoses based on the stories and their experience associated with the condition. Lipkin, for example, explains that cancer is such a broad term, but one’s experience with cancer shapes their idea of what cancer is whether it is deathly or curable, spreads or is localized, is long or short term, etc. With that, one medical term cannot define its characteristics throughout the human population, but it ultimately shapes the perception of the patient and influences the reaction if diagnosed. Knowing that words have different connotations based on the person, it is important for doctors to consider the level of truth about the illness in order to best serve the patient.
2B. Lipkin analyzes that patients often do not understand medical terms like medical professionals understand them. He argues that there is a certain degree of information that each patient should receive. Lipkin quotes “Most patients should be told ‘the truth’ to the extent that they can comprehend it”(p. 146) Medical professionals are responsible for reading their patient and informing them in a way they can understand it. Some patients want to know the full truth, while others should not be given the whole truth, as it would do more harm than good. As a medical professional it is important to read the patient’s intentions, wants, and needs in order to tailor how much truth and information should be told.
2C. Doctors are often criticized as being authoritarian in the way they practice medicine. Lipkin aims to describe that some patients feel like doctors hold all the power in their medical decisions. To argue, doctors are trained professionals that have studied medicine and are supposed to have the patients’ best interest in mind. Some do stray from what is best for the patient, but ultimately it is a profession of caring and success in healing. Some patients believe they deserve the absolute truth about their health, but sometimes the truth should not be told in regards to the betterment of the patient. Doctors are truly in a complicated profession that deals with ethical issues on a daily basis. They are held accountable to judge how to diagnose, treat, and communicate with patients effectively in order to achieve health.
3A. Kant would not support the paternalistic view of truth-telling. Kant believes truth-telling is a moral principle and should be followed in all scenarios. Kant expresses the fact that a lie is consciously making a false statement that is believed to others to be true. We, as human beings, have the right to choose what rules and regulations we follow, also known as being autonomous. Deciding to withhold information fails to respect each person’s autonomy. The paternalistic model explains that the doctor provides or fails to provide information for the betterment of the patient. To Kant, paternalism restricts the freedom in knowing the truth about your body, and to Kant no one should have that power over what is yours.
3B. Kant argues that in any instance lying always cause injury whether it is to the liar himself, to the one who is deceived, or to man kind in general. The liar is injured because their image and integrity is tarnished as a moral person. The liar is also in jeopardy of being exposed as a person of deception, which can break important relationships. The person that is lied to is revoked of control of their possible future. Because they are not fully informed, they are stripped of the possibility to prevent a negative outcome that may not have happened if told the truth. Society is injured because the moral rule to tell the truth fails and could encourage others to act in a similar way and would deplete trust in mankind. In any case, Kant argues that it is our civic duty to tell the truth no matter what the intentions are or else any consequence of that told lie rests on the liar’s shoulders.
3C. Kantian ethics and consequentialist ethics oppose views in the way they view a good action. In Kantian ethics in regards to truth-telling, Kant believes that in any situation one should tell the truth because it is a moral principal and our civic duty. Regardless of the outcome, Kant finds it imperative that the truth is told. For example, if someone was asked if Jews were hiding in their house during the Holocaust, Kant would find it morally right to say yes, putting those Jews in danger. In consequentialist ethics, an act is justified as right or wrong depending on the end or consequences, disregarding the means to get there. If the end was positive, the act was positive and morally justified. To relate, if a consequentialist was asked if Jews were hiding in their house, they would lie in order to keep them safe from harm. In their view any means, even lying, to make a positive end is justified a morally right action. Kantians are concerned with breaking the moral rule, while consequentialists act to produce the best end.
4A. Cullen and Klein agree that in medical scenarios it is impossible to tell the whole truth. The body is a complex system that has parts that are beyond even a physician’s depth of knowledge. They claim that it is important to explain a patient’s condition to the extent that they can understand it and take care of their ailment. Cullen and Klein explain, for example, that a diabetic does not need to know the process of oxidative phosphorylation, but should know the importance of diet and sugar regulation. In that example, phosphorylation is way far beyond what is required to know and take care of their disease. This information would not help the patient, but further confuse and possibly scare the patient into thinking it is a more threatening disease. The degree of complexity hinders physicians to tell the whole truth, but Cullen and Klein find it their moral duty to explain the nature of the condition and the seriousness to allow the patient to understand what is happening to their body.
4B. The “default position” for physicians is to respect each patient as an autonomous being. A patient should have the freedom to decide their medical path. It is the physician’s job to tell the patient the truth, in most cases. By deceiving a patient, you are misinforming them and possibly harming their ability to heal. The physicians that deceive are hindering the patient’s ability to know about their condition. In most cases, physicians should disclose the medical truth to their patients, as they deserve to know. There are some severe cases in which deception can be used, and is considered just, if the patient benefits from this action. In conclusion, physicians, in most cases, should disclose medical information to their patient because they have the freedom as autonomous people to decide their medical course of action.
4C. Cullen and Klein argue that it is acceptable to lie to a patient if the deception is short-lived and the patient can benefit and/or possibly live if deceived. In some scenarios, a patient’s morale can aid in the success towards a healthy future. A placebo, for example, is meant to deceive a patient into thinking the medical intervention will work and studies have shown that the effect can be dramatic. The power of the mind can often positively influence the patient and their progression toward health. Although the physician is lying about the placebo, Cullen and Klein find it morally acceptable to deceive if there are medical benefits. They also explain that physicians need to be conscious of the extent of the deceiving. In some cases, deceiving can overestimate or underestimate the benefits of the deception and violate the patient’s autonomy. With that being said, physicians need to be aware of the information they express and withhold in order to benefit the patient in the most positive way toward health.
5A. Since the time of Hippocrates, doctors have been sworn into medicine under and oath of confidentiality. Confidentiality allows the patient to feel safe to disclose personal information in confidence that the information will not be shared among others. Siegler’s survey concluded that confidentiality is not a reality in modern, high technology healthcare. Siegler found that at least seventy-five medical professionals had access to a certain patient’s files. As we have progressed in technology, doctors’ spans of knowledge are still large, but their expertise is becoming more specialized. A doctor may refer a patient to another doctor because they have more experience with that condition, procedure, medical device, etc. In order to give the patient the best quality care, modern health care has required medical professionals to be experts in certain fields. Due to this fact, many medical professionals have access to a patient’s files because their healthcare team needs to be informed of their health condition. In conclusion, the new developments in technology have hindered the ability to maintain doctor-patient confidentiality because of the progression toward expert fields in medicine.
5B. Siegler does not favor giving up attempts to preserve medical confidentiality as a whole. There is still a great amount of value in providing confidentiality to the patients for their respect. However, the idea that most people have of medical confidentiality must be adjusted and it is necessary that adjustments are made on how records are kept. The original concept of confidentiality is simply unattainable with medical teams. There are many people that are on a need to know basis of the patient’s chart, so there will be many people seeing the information. However, not all people need to see the entire content of the charts at all times. Patient charting needs to be altered, so there can be different sections containing different information about the patient. That way when the chart is moved around to the various people that must see it, they are only able to view the relevant information.
5C. Siegler constructs many possible solutions in order to try and maintain doctor-patient confidentiality. The first solution he describes is one that states that any information shared in a smaller setting, such as physician’s office, should be carefully handled and kept in confidentiality, if no further medical treatment is needed. Next, he describes a solution to allow access to see it only on a need to know basis and explains that certain aspects, like financial status, should be hidden if it is not vital for providing the right care. He then explains that the public should be informed of the term “medical confidentiality.” This term does not mean complete confidentiality because a team of people need access in order provide the best care for the patient. In order to get expert care several medical professionals will need access. Lastly, Siegler constructs the idea to allow patients to read and review their medical records. In defense, Siegler explains that the patient should be in control of their records, so they should be able to restrict access to certain aspects of their file. All in all, none of these solutions are perfect because of the progression toward modern medicine. Expert fields make it hard to restrict the amount of people who have access to patient’s files, but Siegler aims to provide possible solutions to help bring some confidentiality back into healthcare.
6A. Macklin explains that other cultures are not as conventional as the U.S. is. Due to different beliefs in different cultures patients can be harmed because of tolerance of their specific culture. In cultures that do not use pharmaceuticals as often for treatment, a patient could be put in much harm. For example, a patient may need medication, but in some cultures medication is seen as unnecessary and in extreme cases demonic. By tolerating culture over the patient’s need for medication, the patient could possibly be harmed and in much pain. It is important for physicians to find the balance between respect of one’s culture and concern for the patient’s safety.
6B. A patient’s culture is an aspect of the patient’s identity. To Macklin, intolerance to a patient’s culture is disrespectful. He claims “Intolerance to another’s religious or traditional practices that pose no threat of harm is, at least, discourteous and at worst, a prejudicial judgment”(p. 167). Disregarding a part of someone’s identity is not respecting the patient for who they are and what they want. In medicine, it is supposed to be up to the patient to decide their medical course of action and they should be able to deny treatment based on their beliefs. On the other hand, sometimes culture is trumped in respect to the patient’s safety. As explained above, it is important to understand and respect one’s culture, but also take into account the safety of the patient.
6C. In some cultures, patients do not want to know their diagnosis. Macklin aims to describe that physicians can violate a patient’s autonomy because patients in certain cultures do not want to know their diagnosis. They give the right to allow their families to know, but personally the patient does not want to be informed. In certain severe medical cases, medical professionals are obligated to disclose medical information because it is detrimental to the patient’s health. It is disregarding their autonomy because they consciously state they do not want to be informed, but in some circumstances this is trumped by the safety of the patient or what the physician believes should be said.