The Debate Over Truth-Telling to ICU Patients
Describe about the Report for Lying of Doctors to the Patients of ICU?
It is often a matter of debate that whether a physician should tell the truth to patient in order to relieve their anxieties and fears. Numerous arguments based on this context have been enlisted until date, which in turn denotes various parameters of human communication. Not telling the truth in a doctor-patient relationship often requires a special attention. This is mainly because the patients may be harmed to a greater scale. It can be clearly assumed that not only is the patient autonomous is undermines, but the patients who are not told the truth about a particular intervention might experience a loss of trust, which is often essential for healing purposes (Quill et al., 2015). ‘Honesty’ plays a vital role in this entire interaction, which is often seemed to be manipulated by the health practitioners, particularly for the ICU patients.
Based on the Classical Natural Law Tradition (initiating from Augustine and continuing with Aquinas) it can be stated that lying is a sin. However in the factor of medical parameter the factor of moral truth vs. epistemological intervention often seem to encounter to a huge scale by the medical professionals which tend to initiate the factor of uncertainties among the patients. The patients associated to the ICU units are often found to be in a state of bewilderment regarding the health care condition (Ford et al., 2013). This often hampers the medical condition for the patient to a huge extent.
Based on the evidence of Doctor-Patient relationship, it can be clearly argued that it is not erroneous by the medical practitioners to hide the truth regarding improper prognosis or diagnosis. According to the famous Novel ‘The Death of Ivan Illich’ by Leo Tolstoy, it can be clearly analyzed that lying was the right thing to do in several circumstances, which was related to patient- doctor relationship (Wade, 2015). One of the most famous line from the stated novel can be highlighted in order to support the argument, i.e. “This deception tortured him--their not wishing to admit what they all knew and what he knew, but wanting to lie to him concerning his terrible condition, and wishing and forcing him to participate in that lie. Those lies--lies enacted over him on the eve of his death and destined to degrade this awful, solemn act to the level of their visiting, their curtains, their sturgeon for dinner--were a terrible agony for Ivan Ilych”. Thus, from this quote it can be stated that Sigmund Freud paid effective attention to the subtleties of the patient- doctor relationship than almost any other physician. The author highlighted towards the damage which lying does to the doctor, to the therapeutic relationship and the medical professional. The demand for strict truthfulness from the patients of ICU often tends to jeopardize the entire authority. However, based on the clinical context, especially in ICU it can be clearly argued that this concept is wrong in most of the consequences. It can be assumed that less than full disclosure of all the negative possibilities, which might contribute to the actualizing of the possibilities.
Arguments for Not Telling the Truth
It can be often argued that since there are so many medical interventions available, it is obviously not wrong to disclose the truth to a patient when the motive of the medical practitioner is to justify continued intervention (Ubel, 2013). Moreover, in case of concerning one’s own failures from the personal benefit of a medical practitioner, lying to a patient can be justified. Often it can be observed that the medical practitioners and nurses of the ICU tend to support truth-telling strategies, which seem to get displayed by a cruel venture to the patient. Thus, the parameter of intelligence, sensitivity, compassion and commitment need to be analyzed by the health practitioners.
Moreover, when a patient is subjected to high tech tertiary care facility, such as ICCU then it is often observed that the medical practitioner often registers the issue of decisions making. Apart from the parameter of decision-making, the factor of choosing the right person for disclosing the consequence often becomes a challenging situation for the medical practitioner. Thus, on such scenario it can be argued that the truths need to be disclosed to a certain level unless there is no opportunity for the health practitioner to reveal the fact. Traditionally, it is observed that the doctor is alone responsible for all the communication. Thus, systemic handling of the communication parameter should be assessed in order to prevent from effective consequences. However, nowadays it is often observed that the social workers along with the nurses associated to the ICU department are found to be responsible for truthful communication with the patients and their family (Green, 2015). As most of the employees associated to the health care institutions are found bounded to institutional policies (which includes the Patients’ Bill of Rights), coordination of truth telling is also more of a problem.
It can be stated that a professional obligation often tend to link the patient’s autonomy. In such a situation, the autonomists tend to refer to as full disclose of the consequence. It can be stated that this is not sufficient to tell only a partial truth. The radial associated to the patient autonomy focuses in eliminating the nurse or physical discretion or requires the fact that “every fact should be revealed as only the patient can determine what s appropriate to the context”. The other principles include non-malfeasance, beneficence and confidentiality need to be given minimal considerations into subordinate obligations.
Arguments for Telling the Truth
Often the autonomists’ insist regarding the full disclosure, which usually set aside questions about the uncertainties, which permeate the clinical context. Nevertheless, the medical diagnose along with the following therapeutic regimes rarely matter of the mathematical certainty. The psychiatric diagnoses of the ICU chamber tend to develop from the hypotheses which are then tested through the contusing symptom evaluation. These are carefully watched for the response of the therapeutic interventions. However, several questions still arises regarding the uncertainties of doctors and patients. The effective questions related to this context are as follows: “Does every feasible hypothesis requires disclose to a patient? Is every bit of data about a disease or therapy to be considered information to be disclosed?”
On a general note, it can be argued that relative certainties along with realistic uncertainties tend to belong within the honest disclosure of the requirements. This is mainly due to the fact that they qualify as information which a reasonable and efficient person needs to know to manifest right health care decisions. However, the reasonable and efficient persons do not want full disclosure, even when the fact can be disclosed, or is feasible to disclose by the health professionals. This is required for prompt and effective decision-making in order to implement right health care decision. However, reasonable and significant person do not want full disclosure of the information, even when it is found to be feasible (Toombs, 2013). Thereby in such cases, telling the truth in the practice of clinical factor can be considered as an ethical obligation, but determining the factor which constitutes the truth needs clinical judgment. Autonomy cannot be the only principle, which needs to be involved (Donnelly & Psirides, 2015). The factor of autonomy cannot be considered as the sole principle involved in this context. The truth need to be linked with the beneficence along with justice and protection of the community.
The concept of ethics associated to a dying patient of ICU unit also needs to be analyzed significantly. It can be clearly stated that no one could pretend to speaker for every patient in every context, but on a general note, truth need not be disclosed. For example, when a patient suffering from cancer and admitted to ICU should be denied from attending any bad news regarding. Many argue that the patient should be informed about their health consequence, even if has a very fatal information (Christensen & Probst, 2012). However, it can be stated that this might depress their moral to a huge extent, which is not appropriate at that time. The patient might resist from further diagnosis, due to mental retardation. Hence, it can be clearly argued that the truth should not be disclosed completely to such a patient who need significant medication program.
The Role of Autonomy in Truth-Telling
Without the disclosure of the truth in a dying situation, patients are likely to be subjected to aggressive treatments which would turn the dying to a more painful, dehumanizing and expensive protocol. It is considered as a kind of a situation, which contributes towards the increasing support for the enthused movement. Most of the patients are found to be rightfully afraid regarding knowing the truth regarding their medical condition and therefore would die only after a futile interventions, dehumanizing isolation and protracted suffering. On the other hand, it can be clearly assumed that the benefits of being told truth may be considered substantial. An example of the situation is the improvement of pain management, improvised response therapies, etc.
However, based on the above parameters regarding the positive aspects of disclosing the truth, one can clearly argue regarding its negative aspects, which is much more effective and significant. It can be analyzed that truth telling associated to every clinical context must be sensitive and thereby taken into consideration of patient’s personality along with patient’s clinical history. In the complex situation, it is quite difficult to draw a line between violation of truth and truth disclosure. Most of the reasons might be advances in order to justify the situation significantly. The medical practitioners to monitor the consequence can efficiently follow not telling the complete truth (Baggs et al., 2012). However, filtering the truth that needs to be disclosed and keeping confidential that needs to be assessed by the medical practitioner is significant in order to pursue effectiveness in decision-making. The factors of outright are rarely excusable. Something less than the full or the factor of complete truth is almost inevitable. From this viewpoint, it can be stated that a reliable and dignified is not just goof at prescribing efficient medicine or has a decent approach, but also possess a good judgmental skill in deciding on the principle of truth telling, especially in the context of ICU critical patients.
An efficient medical practitioner would definitely help in minimizing these parameters of uncertainties that are commonly found to be associated to the ICU patients by focusing on this principle of truth telling. Thus, a complete argument of the paper regarding the relationship of doctor and patient should be based on trust, and not be influenced by insensitive communication factors.
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