Deception in healthcare is a controversial subject. Today's society is that of the informed; in other words, the healthcare provider-patient relationship today is that of cooperation, where the patient is fully informed and is a partner in his or her healthcare decisions. Additionally, society today is expected to be more knowledgeable and aware of their health which is attributed to the readily accessible medical information to the public through the internet and mass publication of continuous studies in the healthcare fields. Healthcare has evolved over time and the physician-patient relationship is a shared responsibility. Therefore, today's modern physician-patient relationship deception is not warranted unless there are exceptions justifiable reasons for the use of deceit as discussed in the following scenarios.
The first scenario whereby a physician intentionally submits faulty information to an insurance company in an attempt to help a sick patient pay for needed health care services. This scenario portrays the way fraud is raging in healthcare organizations. On consisted foundation, professionals in healthcare industries face ethical dilemmas. Ethics comprises of behaviors describing principles that affect human beings. In this case, the physician is at the crossroads to help the patient to pay the medical bills. The physician is always aware of that by doing so, he/she is committing fraud. Some people want to access the funds available for medical care to patients who need beneficial services at all levels. This problem happens in the form of billing patients for unprovided services.
Therefore, before physicians indulge in any unethical behavior, they should be aware that if they are caught, they will face the consequences. In this scenario, the physician, despite wanting to help the patient, he/she should have ethical courage. The lack of it can hinder other virtues that lead to positive development. If the physician commits fraud and get convicted, he may be subject to fines or jail terms.
In the second scenario, a physician recognizes that patient has psychosomatic symptoms and prescribes a placebo pill in hopes that the emotional relief of the placebo will help the patient recover. In this instance, a placebo is anything given to a patient either orally or in an injection form with prior knowledge that it has no medical effect, with a hope that it will alleviate the symptoms of an illness. It is a fact that for placebo to be successful, deception is often considered necessary. In general, the use of a placebo to deceive a patient is not ethically justifiable because it goes against the ethical principles like respect for patient's autonomy and informed agreement. It can also lead to undermining of the relationship between the patient and the physician. Another reason why placebo is not justifiable is that it comes to disease mongering whereby healthy people are seen to require treatment and thus converted into patients (Braillon, 2015). On the other hand, placebo is acceptable in some situations. Deception is justified if the reasons include the prevention of psychological or physical harm, including death, the emotional or cognitive impairment of the patient or the belief that the patient is willing to be deceived.
In the third scenario, a physician does not provide full disclosure of a surgical procedure of a surgical procedure because he/ she suspects the patient is not emotionally stable enough to handle all the details of the surgery, treatment, and recovery. When physicians are communicating with patients, being honest is the best way to build trust and is a sign of respect to the person that is unwell. Munson (2013), states that revealing information that is truthful to the patient is helps them to become participants that are informed to make healthcare decisions. Therefore, it is essential that patients should know the truth about their illness and any other information that is relevant.
Just like in this scenario, many physicians are afraid of disclosing too much information to the patient, because they worry about the harmful effects it may cause to the patient. Facts that are important to the patient will give him/her an ability to be an active and knowledgeable participant in the process of decision making. Therefore, when a physician discloses the truth, he should ensure that he does not reveal brutally but with suitable sensitivity to the patient's potential to take in the complicated or bad news.
There are acceptable circumstances where the patient may not be told the truth. First, if the physician has reasonable proof that disclosing the real information will cause predictable harm, like committing suicide by the patient. The second circumstance is if the patient prefers not to be told the truth and requests the physician to consult the family member. In this case, it is crucial that the patient has to think about the outcomes of rejecting their responsibility in decision making. If they chose to make an informed decision that a doctor should withhold told the truth, then the preference should be respected.
In first scenario, a physician accepts pharmaceutical perks if they recommend a specific drug for treatment. In this scenario, the physician is taking a bribe to market a certain brand of medicine. Bribery is illegal, and the healthcare market is aware of the federal Anti-kickback statute. It is a sad fact in conventional medical care because the physicians tend to prescribe substandard medicines and poor quality drugs to the patients. The physicians involved in accepting perks have lack moral and ethical behavior that is supposed to govern them in their profession. Physicians are paid lots of money by manufacturing companies to prescribe one brand or one particular type of drug. This activity is dangerous because it destroys the relationship between the physician and the patient.
In the second scenario, when prescribing pain medication, some physicians may undertreat a patient if they sense their patient may have a propensity for addiction. The management of pain has been the first responsibility of every physician. (Doyle,1999) acknowledges that most medical practitioners are not able to assess and manage pain despite the fact that there is a tremendous advancement in pain medicine. Physicians have the responsibility to treat a person who is in pain. They are responsible for handling a patient's pain and suffering. Like in this scenario, the physician undertreated the patient for fear of addiction. This is violating the rights of the patient because studies suggest that every pain can be relieved. The physician most likely lacks sufficient knowledge regarding treatment of pain because, evidence confirms that painkillers do not cause addiction. Therefore if a physician is not able to assess and treat the pain, he/ she should refer the patient to a pain specialist. Undertreating pain breaches respect for persons and beneficence and results to an addition of costs to patients and society both directly and indirectly.
In the third scenario, a physician treating a patient with a terminal illness fails to disclose secondary ailments diseases which may arise (in an attempt to protect the patient's emotional stability and will to fight). This dilemma relates to the ethical principle of the wellbeing of the patient (Edward, 2014). The principle of beneficence states that the physicians should work to promote quality and inhibit harm. On the other hand, withholding the truth relates to the principle of non-maleficence. After analyzing this scenario, physicians should stand by his profession policies and allow the patient to have clinical information concerning the illness, including its prognosis, treatment and possible outcomes however worse it can be.
Telling the truth to a patient with a terminal illness is a big dilemma that physicians engage with regularly. Physicians, on all occasions, are at a better position in the hospital to handle patients and therefore, they must be ready to reveal truthful information to patients and be willing to support them together with their families when he/she has already disclosed the truth. Truth- telling needs to be done promptly and in a sensitive manner. If the physician fails to reveal the truth to a terminally ill patient, then the relation between the patient, his/ her family and that of the physician can be in jeopardy.
I have been a victim of misleading by a physician. While in university I started to experience a mild headache and would take the painkillers to relieve it. I did that for one week, but there was no improvement. My parents took me to our family doctor. After explaining my symptoms, the doctor concluded that I might be experiencing migraines. She administered to me an injection and some oral painkillers and advised to have a rest. On the same night, I once again experienced a headache now with strong intensity. I could not sleep at all. My mother called the family doctor who responded immediately. Since I was in poor state, the doctor injected me with a diazepam drug (I later came to learn that it is used to treat anxiety, alcohol withdrawal syndromes, muscle spasms) which gave me instant relief. With time, I could use diazepam on a daily basis not knowing that I have created an addiction. I was using a wrong medication to treat unknown illness
When my family realized that I could not do without diazepam, they decided to seek for a second opinion from another doctor. One of our family friends connected us to a neurologist, who after sending me to do several medical tests, and the specialist diagnosed me with a condition of immunity where my white blood cells were fighting against each other hence the headache. The doctor gave me the correct medication, and in six months, the pain had disappeared. Although the family doctor enabled me to get immediate relief from the pain, she deceived me. The doctor was willing to help me, but administering me with wrong drugs was deceit of the highest order. The deception was beneficial for a short time but if I would have continued to take diazepam, the harm could be unexplainable.
The question of deceiving patients is a challenging one for Christians. In Ten Commandments, there is one that forbids people from lying, the ninth commandment. It distinctly warns people against bearing false witness (Exodus 20:16). As we all know, it requires a great amount of faith to obey God's commandments. Thus, in healthcare services, a physician would have to make a decision based on his or her trust and faith in God. First, physicians must understand that being forced to lie to save someone's life is a very unusual circumstance. It does not matter if someone has to lie or not. The gospel truth is that Jesus Christ is in charge of controlling every person's life and is also able to notice people's intentions. Therefore, clinicians should not be distressed over what will happen, if they reveal the truth about a patient's illness. They should place their trust and obedience in Christ and to let Him do the reigning, as Isaiah 46:10 states that for we are not aware of the future because God knows the beginning and the end of everything.
Braillon, A. (2015). The Good, the Bad, and the... Empathic. The American journal of medicine, 128(8), e27.
Doyle, D. (2008). Through One Man's Eyes. A 30-year retrospective on ethical issues in palliative care.
Edwards, S. (2014). Telling the truth? Nursing ethics, 21(4), 383-384.
Munson, R. (2013). Intervention and reflection: basic issues in bioethics. Cengage Learning.
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