The Lies We Tell in the Exam Room

By Abigail Zuger
The New York Times - Well Column
Published April 22, 2013

Here are some excerpts:

In a recent issue of The American Journal of Bioethics, a half-dozen ethicists chewed over the question of whether a decision to play Robin Hood with the medical insurer is actually ethical. Say that the patient’s health — or even life — is at stake: The insurer, for example, is refusing to pay for an essential test or medication unless the doctor writes down a bogus diagnosis the patient does not have. The experts came down firmly and eloquently on both sides of the issue.

Nicolas Tavaglione and Dr. Samia A. Hurst, both at the Institute for Biomedical Ethics at Geneva University Medical School in Switzerland, argued that lying for a patient under such circumstances was not only ethically permissible but mandatory. Helping a patient takes precedence over all other considerations, they wrote. Telling the truth would be “honoring an ideal principle in a nonideal world.”

Other ethicists protested, pointing out that too many doctors playing Robin Hood would make insurers tighten purse strings further. Dr. Thomas S. Huddle, of the medical school at the University of Alabama, Birmingham, wrote that all lies, even those told for a good cause, imperil the moral fabric of medicine. Dr. Robert M. Sade, of the Medical University of South Carolina, feared instead for the moral fabric of the doctor, pointing out that every lie “reinforces the habit of lying,” which then becomes easier and easier until the “morally disengaged” doctor is capable of really bad behavior.

The entire article is here.

Lying to Patients: No Huge Ethical Failure, Says Bioethicist

By Art Caplan, PhD

Medscape: Ethics

Dr. Art Caplan

Today I would like to talk to you about a pretty thorny subject and one that is fascinating because it is so ethically rich: Should doctors ever lie to their patients?

The trigger for this discussion is a study that just came out that found that doctors do lie. In fact, the study found that 20% of more than 2000 doctors surveyed admitted that they had not told patients the truth when an error had taken place. They found out that more than 10% hadn't discussed financial conflicts of interest, and 15% said they gave a rosier picture about prognosis and risk and benefit with respect to a disease.

There has been a good deal of interest in this survey, and the public and some media reports are saying that this is shocking. We expect our physicians to always be truthful; this survey apparently shows that there is a considerable amount of lying going on, withholding of the truth, and not being forthright. What's wrong? Is there a huge ethical failure going on out there among doctors and medical practitioners?

The answer is no. It is inexcusable and not advisable to lie about an error. You may dodge a bullet on that one by having the patient not find out, but if it really affects their care, if they wind up harmed, if they wind up having to pay more and it comes out later that you didn't tell the truth or that there was an omission of the fact that an error occurred, you are going to get clobbered. I have seen it again and again in courtrooms. It may seem the easiest way out, to avoid telling the truth when an error takes place, but getting it out there and getting it over with early is the best protection in terms of malpractice associated with error. It isn't lying.

The entire story and video is here.