Case Study 31 : DISTRESSING TRUTH
Challenges
A 32-year-old female, G4P4, admitted due to abdominal pain, was diagnosed with cervical carcinoma, stage III; she underwent cobalt therapy. Doctors contemplated total hysterectomy, but remain unsure of her prognosis.
Question
What are some considerations when informing patients of their precarious condition?
Solutions
The goal remains telling patients the truth of their condition. However, one should also prudently try to minimize the distress some painful truth could bring about. One must thus seriously consider the manner of informing the patient.
At times the whole truth need not be told:
1. When we do not know the whole truth (a cancer patient’s prognosis).
2. When the listener cannot totally understand the whole truth (medical details of a complicated disease).
3. When the listener has no right to the truth (a patient’s curious friend asking for details on the patient’s disease).
4. When, at the present moment, the patient cannot handle the situation; in this case, waiting for the right circumstances works best. Note that “partial truths” understood this way are acceptable, being entirely different from mixing truths and falsehoods.
What a patient really needs is information essential to come to terms with reality, to plan, and to make decisions. Thus, distressing details that would not at present contribute to such need may be covered in very general terms or even omitted entirely, at least for the moment, unless the patient asks specifically about them.
On the other hand, not giving information they need would seriously mislead them about their condition, thus impeding them in planning and decision making. One should choose the best time and circumstances for talking with patients – avoiding hurried interactions, outsiders hearing the conversation, or when patients feel stressed or exhausted. [REFERENCE: Ashley, OP, Benedict M. and Kevin D. O’Rourke, OP, Health Care Ethics: A Theological Analysis, 4 ed., Georgetown University Press, Washington DC 1997.]
