Question

Watch the TED Talk, What Your Doctor Won't Disclose.

Discuss what the ethical issues are that are disclosed in this talk. How does the relationship between doctors and pharmaceutical companies affect the cost of healthcare for the patient?

Answer 1

The epidemic fear and the importance of transparency within the healthcare system, which is a harbinger of much contention within the healthcare field. This issue is tied to the ethical principle of beneficence. Beneficence is an ethical component that requires the physician to act to the benefit of his or her patient. When it comes to medical records, medical errors and financial disclosure as well as informed consent, transparency is important in order to fulfill the principle of beneficence. In medical school, students learn the importance of transparency and how it can improve outcomes and reduce instances of malpractice, but in clinical practice, many physicians are afraid of disclosing information that does not relate to beneficence such as core values and political affiliation to their patients. Disclosing this information goes beyond the subjective standard of disclosure. Subjective standard of disclosure is taking the patient’s core beliefs into consideration and disclosing medical information that is relatable to the patient.

The codes of ethics of the health professions began to reflect this important shift in opinion. The American Nurses' Association's Code for Nurses linked disclosure with truth-telling and self-determination: "Clients have the moral right … to be given accurate information, and all the information necessary for making informed judgments." The code counseled nurses to avoid "claims that are false, fraudulent, misleading, deceptive, or unfair" in their relations with the public (American Nurses' Association,).

Patients' powerful emotional reactions and personal transformations during grave illnesses involve caregivers in intimate, significant connections with patients. The belief that knowledge of death is healthy has changed the image of the clinician from that of maintaining a cool distance to one of performing emotional work with patients . Ethicists often suggested that health professionals who withheld information from patients reflected several concerns: denial of their own and the patient's fear of dying, unconscious wishes to foster dependency in their clients, concern that discussing death constituted admitting failure, and manipulation of hope to encourage more extensive treatment choices.

Legally, the information in the hospital record belongs to the patient , but patients are not employees, and so patients' rights are hard to define procedurally. Patients' responsibility to provide honest disclosure to healthcare staff similarly lacks explicit definition. Thus, although large healthcare institutions have fostered a need for improved communication with patients and made systematic deception difficult, smoothing the flow of appropriate information to patients presents a daunting institutional task.

In healthcare, the principle of full disclosure stands in a reciprocal relationship to the obligation to keep confidentiality. Clinicians often have an obligation to disclose information to the patient, and at the same time, keep the same information from others. Moral judgment requires appreciating the range of application of both principles, that is, knowing which information should be disclosed or withheld in what circumstances (Jonsen and Toulmin). The more formal arguments justifying disclosure parallel the arguments for informed consent by appealing to autonomy, but broader notions of serving patient psychological good and building relationships provide less clear guidance as to the full extent of disclosure. Although favoring disclosure of a fatal diagnosis, as the worst possible news, has tended to encourage wide disclosure of less frightening information, it is still unclear what patients should or should not be told about hospital procedures, student participation in procedures, financial information, names of manufacturers, opinions on the skills of clinicians, personal information about practitioners, mistakes, and so on.

Prevailing uncertainty has motivated some physicians to argue that the truth is so uncertain and variable that veracity is irrelevant to patient care. They argue that prospects and options can be framed in so many ways that clinicians inevitably control patient decisions. Even in the relatively well-studied area of informed consent, what to tell about unlikely dangers remains a contested area. Although some physicians have chosen to limit disclosure on the grounds of uncertainty,

.Specific Concerns in Disclosure

Although terminal diagnoses have served as the paradigm for exploring disclosure, they cover only a portion of the possible concerns involving communication with patients. This section briefly describes a few of the other concerns. Many can arise, such as using placebos; therapeutic privilege; giving patients information about the costs of care; disclosing brain death to the family; lying to an insurance company to obtain coverage for a treatment or diagnostic test; falsifying records to help patients escape war service or school busing; reporting an accidentally discovered serious condition to the patient when the doctor-patient relationship is undefined; offering information to patients concerning futile therapeutic options; deceptively introducing medical students to patients as doctor; concealing the histocompatibility (mutual tolerance of tissues or organs to be grafted) of an unwilling potential organ donor; revealing to patients that a caregiver has tested positive for the human immunodeficiency virus (HIV); revealing HIV diagnoses to patients; encouraging patients to disclose HIV diagnoses to sexual partners; communicating psychiatric interpretations to patients; expecting disclosure by patients to health professionals; and disclosing genetic information to patients.

DISEASES LACKING EFFECTIVE TREATMENT. When a diagnostic test can predict a dread and incurable disease— such as Huntington or Alzheimer's disease—some physicians consider the possibility of withholding the diagnosis. An instrumental view of communication tends to support the view that the burden to the patient of knowing outweighs the value of disclosure.

DISCLOSING DIAGNOSTIC TESTS. Hospitals and clinics often screen patients upon admission for a wide range of conditions without informing them of the reasons for testing. Services may standardly screen for HIV, sexually transmitted diseases, or pregnancy without informing the patient. They may also wish to make surreptitious tests when they believe a patient is claiming false symptoms.

REVEALING MISTAKES TO PATIENTS. Surely, practitioners should tell patients of mistakes pertinent to their welfare or requiring changes in treatment plans. However, the possibility of lawsuits, the fear of losing patient confidence, painful feelings of incompetence, and solidarity between healthcare team members often outweigh patient benefits in frankness regarding errors.

PATIENT REFUSAL OF INFORMATION. The bioethics literature has debated the proper handling of patient refusals of information (Ost; Strasser). On the one hand, the literature usually has regarded refusing information as an autonomous choice and therefore has supported it: A caregiver may ethically choose to respect a patient's wish to rely more heavily on the caregiver.

DISCLOSURE TO FAMILY MEMBERS. Kübler-Ross suggested entrusting some information to family members rather than the patient; this has also been the pattern reported in several countries