Detoxicol

SDLS 2008
Medicine for the intoxicated
Subject: Bioethics Lecture Date: July 22, 2005
Topic: Truth Telling Transcriber(s): Jaime Aherrera
Lecturer: Melchor Frias M.D. No. of pages: 2

THE PRINCIPLE OF TRUTH TELLING

TRUTH TELLING
 information on the sickness –Serious or Not– must be furnished to the patient even if he does not
ask for it
 in informed consent, remember that it is any information about the patient
 in truth telling, the patient needs information regarding his/her disease

TRUTHFULNESS
 the ordinary ethics of truthfulness is generally summed up in two commands:
1. Do NOT Lie!
• if you communicate, DON’T Lie!
 example: we can chose not to communicate with the relatives of patient

2. You MUST Communicate with those who have a right to the TRUTH
• you must communicate, if the other person has a right to communication
• Who has the right to communication of the truth?
 Patient!
 example: Relatives have no right to communication
 doctor doesn’t owe loyalty to relative

LYING
 in line with the GENERAL APPROACH OF PRACTICAL
WISDOM, one could judge the ethics of lying in terms of its consequences for the individual and for the social
system of communication
• when we lie, trust is broken
 lying is termed as “Speech against the
Mind”
• he is saying it, but in his mind, he knows
it is not true!!!
 in bioethics, Lying is termed as
FALSEHOOD
 a falsehood in those circumstances in
which the other has a reasonable expectation of the truth

***Truth-Telling promotes a Better Doctor-Patient Relationship

REASONABLE EXPECTATION OF THE TRUTH

 the expectation of the patient for the doctor to “Tell the Truth”
 when the other has Reasonable Expectation of the Truth, a Falsehood will:
• Breakdown Communication
• Render Social Cooperation Difficult

Three Factors which Determine whether there is Reasonable Expectation of Truth

1. Place of Communication
• there is NO Reasonable Expectation of the Truth if we talk in a Public Place, Canteen, etc
• inappropriate place: patient should not expect you to answer truthfully bec confidentiality will be
broken
• it EXISTS in Private Places (Clinics, etc)  for Confidentiality and Cooperation
2. Roles of the Communicators
 • patient-doctor relationship establishes REASONABLE EXPECTATION OF TRUTH
 patient expects truth from doctor

• doctor expects that the patient will give him information to help in the diagnosis

• roles establish Mutual Cooperation  Establishes Reasonable Expectation of the Truth

• doctor has no loyalty to relative, unless the patient gives permission to the doctor to tell the truth to
the relative

3. Nature of the Truth Involved

• it depends on the Information being asked
• example:
 the Dean has the authority to know the grades of students
 however, if Dean asks about the counseling of a teacher to the student, the dean has NO
Right to know the truth  Confidentiality (ex. Buntis ba siya?)

Purpose of the Three Factors

 all the three factors, which determine the reasonableness of the expectation of the truth are:
• specifications of the Obligation to Minimize Evil
• to Justify the Tolerance of Evil by a proportional Good
 Benefits > Harm  Tell Truth!

PRINCIPLES OF TRUTH TELLING

 justification of the REQUIRED MORAL PRACTICE

• human dignity
• informed consent
• confidentiality
• right to privacy
• autonomy
• right to know the truth

ISSUES IN TRUTH-TELLING

A. Truthfulness in Volunteered Information

 even if a patient does not ask, the Patient must be told whatever is relevant
 this now creates a Reasonable Expectation of the Truth
• patient expects doctor to tell the truth
 even when the person volunteers information, other persons cannot reasonably expect the WHOLE truth that is
unless the informant tells them they will get the whole story

B. Right to the Truth

 this is important for Informed Consent so that patient can decide on procedures
 truth by purchase:
• when person comes for information (not just treatment), the fact that he paid for the information
 he deserves the TRUTH!

 for important Non-Medical Decisions

• example:
 dying Patients
 doctor should tell the truth that he would die
 should be told soon so that he can prepare his will, make amends with people,
confess to a priest

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