Deception as Therapy:

Question

A 46-year-old man, coming to a clinic for a routine physical check-up needed for insurance purposes, is diagnosed as having a form of cancer likely to cause him to die within six months. No known cure exists for it. Chemotherapy may prolong his life for a few months, but will have side effects the physician does not think warranted in this case. In addition, he thinks this therapy should be reserved for patients with a chance of recovery or remission. The patient has no symptoms giving him any reason to believe he is not perfectly healthy. He expects to take a short vacation in a week.

For the physician, there are now several choices involving truthfulness.

1. Ought he to tell the patient what he has learned or conceal it?
2. If asked, should he deny it?
3. If he decides to reveal the diagnosis, should be delay doing so until after the patient returns from vacation?
4. Finally, even if he does reveal the serious nature of the diagnosis, should he mention the possibility of chemotherapy and his reasons for not recommending it in this case?
5. Or should he encourage every last effort to postpone death?

 

Which option would you choose and why?

Answer 1

Whose life is at issue? The patient, Bob, has a life and has responsibilities in life, to others and to himself. The physician has made a professional promise — the Hippocratic Oath — and our reasonable understanding of that oath is that the physician will not act to harm us, but consider the harm the physician would do in lying to Bob. Can Bob properly do his duties to others and himself if he labors under a deception? Is Bob the owner of his life or not? Bob might not even correctly decide to get a second opinion if his physician lies to him. The physician should not act to remove Bob from his ownership of his own life. Bob should decide whether or not to accept the physician’s truthful diagnosis. Bob should decide whether or not to accept the physician’s well-considered advice about treatment. Bob should be supported, not subverted, as he carries out his responsibilities.