Telling a patient that he is to die: A moral dilemma.

Physicians face more and more ethical dilemmas during their practice nowadays,
especially when they are taking care of the patient at end of life stage. Patients place a
great deal of trust in their physician, and may feel that trust is misplaced if they discover
or perceive lack of honesty by the physician. Yet there are situations in which the truth
disclosed can be too brutal, or may have a terrible impact on the patient.
To start with, contrary to what many physicians have thought in the past, a number of
studies have demonstrated that patients do want their physicians to tell them the truth
about diagnosis, prognosis, and therapy. In addition patients want be told all relevant
aspects of their illness, including the nature of the illness itself, expected outcomes with a
reasonable range of treatment alternatives and risks and benefits of treatment.
Furthermore, in short-term relationships between doctors and patients, where decisions
have to be made in a compressed period, there is less opportunity to worry about the
impact of truth on the patient. However, in long-term relationships truth is likely to be
withheld for compassionate reasons more readily. However, it is important to remember
here that “truth will always out.”
On the other hand, there are many physicians who worry about the harmful effects of
disclosing too much information to patients. Assuming that such disclosure is done with
appropriate sensitivity and tact, there is little empirical evidence to support such a fear.
Moreover, there are two main situations in which it is justified to withhold the truth from
a patient. If the physician has some compelling reason to think that disclosure would
create a real and predictable harmful effect on the patient, it may be justified to withhold
truthful information. Examples might include disclosure that would make a depressed
patient actively suicidal.
Additionally, the second circumstance is if the patient themselves states an informed
preference not to be told the truth. Some patients might ask that the physician instead
consult family members, for instance. In these cases, it is critical that the patient give
thought to the implications of abdicating their role in decision making. If they chose to
make an informed decision not to be informed, however, this preference should be
respected.
In conclusion, I would like to say that it is a doctor’s responsibility to tell patients the
truth, to help them to understand even the most devastating realities and provide support
and realistic hope to grieving family members