The principle of respect for autonomy requires informing patients adequately and appropriately about diagnoses, treatments, and prognoses. However, some clinical cases may cause ethical dilemmas regarding telling the truth. Under the existence especially of certain cultural, social, and religious circumstances, disclosing all the relevant information to all pertinent parties might create harmful effects. Even though the virtue of telling the truth is unquestionable, sometimes de facto conditions compel physicians to act paternalistically to protect the patient/patients from imminent dangers. This article, (...) which aims to study the issue of whether a physician should always tell the truth, analyzes an interesting case that represents the detection of misattributed paternity during pre-transplant tests for a kidney transplant from the son to the father in Turkey, where social, cultural, and religious factors have considerable impact on marital infidelity. After analyzing the concept of telling the truth and its relationship with paternalism and two major ethical theories, consequentialism and deontology, it is concluded that the value of the integrity of life and survival overrides the value of telling the truth. For this reason, in the case of a high possibility of severe and imminent threats, withholding some information is ethically justifiable. (shrink)

In “Nudging, Bullshitting, and the Meta-Nudge”, the author responds to William Simkulet’s claim that nudging is bullshitting (according to Harry Frankfurt’s analysis of bullshit and bullshitting), and therefore nudging during the process of informed consent renders consent invalid. The author argues that nudging is not necessarily bullshitting and then explains that although this issue is philosophically interesting, practically speaking, even if nudging is bullshitting, it does not follow that nudging necessarily renders informed consent invalid. This is obviously true in those (...) situations in which nudging during the process of informed consent is unavoidable. The author concludes with a discussion of the meta-nudge and suggests that physicians can use the meta-nudge to eliminate or decrease the power of inappropriate, problematic, or undesirable nudges. (shrink)

Providing patients with information is fundamental to respecting autonomy. However, there may be circumstances when information may be withheld to prevent serious harm to the patient, a concept referred to as therapeutic privilege. This paper provides an analysis of the ethical, legal and professional considerations which impact on a decision to withhold information that, in normal circumstances, would be given to the patient. It considers the status of the therapeutic privilege in English case law and concludes that, while reference is (...) made to circumstances when information (primarily in relation to risk disclosure) may be withheld, further clarification is required on the status of therapeutic privilege. I suggest there has been shift in English law relating to the standard of information disclosure towards one set by the test of the reasonable, prudent patient. It is this shift that necessitates the existence of a therapeutic privilege which enables doctors to withhold information that would usually be given to the patient in order to prevent serious harm. I then explore the professional guidance in relation to information disclosure and how this relates to the legal position. There are strong ethical arguments in favour of disclosure of information to patients. In light of these, further clarification is required to identify and define the grounds on which this exception exists, the information that could lawfully be withheld and how this exception extends to rest of the health care team, particularly nurses. As such, explicit ethical and legal scrutiny of therapeutic privilege is needed in order to consider how this concept might be articulated, constrained and regulated. (shrink)

Background and Objectives: Patient autonomy is a recognized principle in modern medical ethics, and truth-telling to the patient; thus, it holds special importance for its contribution to this principle. In practice, however, several challenges emerge that can lead to different responses. This difference is more marked in studies conducted in the Eastern and Muslim countries due to variations in cultural and religious beliefs. Truth-telling is a challenging concept respecting placebos, medical errors, and delivering bad news on diagnosis and treatment to (...) patients. Methods: This study employed an unsystematic review of library and online sources, as well as databases, including Google Scholar, Springer, PubMed, Ovid, and relevant Persian papers in an attempt to provide an overview of this concept and study the Islamic view, particularly the Shi’ite perspective, and the predominant approaches employed in Muslim countries. Results: Islamic scripture and hadith strongly advocate honesty and truth-telling. However, maleficence to patients and exposing them to serious harm is unallowed, and withholding the whole or a part of the truth; even lying is justified in extreme cases. Conclusion: Essentially, the philosophy of medicine is based on helping patients and reducing their pains. Considering the unique condition of each patient, a perfect solution cannot be prescribed for all of them and the same strategy to manage all cases. The emphasis on truth-telling in the Islamic view is no less than other schools of thought. However, if disclosing the truth may expose the patient to certain, serious biopsychological risks, denying the whole or a part of the truth might be advisable; even in frequent cases, lying can be justified to protect the patient. (shrink)

ContentTruth-telling is an integral part of medical practice in many parts of the world. However, recent public inquiries, including the Francis Inquiry reveal that a duty of candour in practise, are at times compromised. Consequently, the duty of candour became a statutory requirement in England. This study aimed to explore clinicians’ perspectives of the implications of the legislation for medical ethics education, as raising standards to improve patient safety remains an international concern.MethodsOne-to-one interviews with clinical educators from various specialties who (...) contribute to the MBChB programme at the authors’ university. Once data saturation had been assessed, transcripts were analysed using a thematic approach by the following concurrent activities: data reduction and coding into themes. Example quotations are used to illustrate that key themes are grounded in the data.ResultsEleven clinical educators were interviewed; three general practitioners, six physicians and two surgeons. Thematic... (shrink)

Being truthful with patients is a critical foundation of the doctor-patient relationship and is fundamental to development of trust. A professional commitment to truth telling may sometimes contradict other principles of bioethics, which may challenge decision-making for the doctor and/or the treatment team. Practitioners may fail to address all ethical or legal aspects of a case and therefore make inappropriate decisions.