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Transcript of Truth Telling
Autonomy & Truth Telling
Defining our Terms
Act vs. Rule Utilitarianism
Truth Telling Case Study
HIV Case Study
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Violations of Autonomy
Truth Telling & Confidentiality
Bioethics Lecture 8
Should truth telling and autonomy be collapsed into one?
Why or why not?
Truth Telling: Historical Context
The Hippocratic Oath does not include the principle of truth telling.
The professional code of the American Medical Association did not include truth telling (until 1980).
To be compassionate,
we must withhold the truth.
"The art of medicine consists largely in skillfully mixing falsehood and truth."
What does this mean? Why was this the dominant approach in the 20th century?
Do you agree with this statement?
Truth Telling: Arguments
Telling the truth can cause injury, as it evokes feelings of panic, hopelessness, etc
Patients may not want to know the truth.
Patients may not understand what's going on.
Informed patients are better patients
Lying causes distrust in both this instance & more generally
Truth Telling: Applying Ethical Theories
Kant: What would he argue?
Something about a mean.... ?
Utilitarianism: What about Mill?
Adding to the Toolbox: Act vs. Rule Utilitarianism
A person's act is morally right if and only if it produces the best possible results in that specific situation.
: An action is right as it conforms to a rule that leads to the greatest good, or that "the rightness or wrongness of a particular action is a function of the correctness of the rule of which it is an instance".
It might be OK to lie... depending on the situation.
If telling the truth does the greatest good overall (for the society), then it does not matter if the individual act produces the greatest good in that instance.
(Start at 7:00)
Truth Telling: Imparting information to patients.
Confidentiality: Patients imparting information to health care professionals
& the promise that these professionals will not disclose this information to others.
I promise not to tell!
Helps to provide an environment where patients feel secure enough to provide private information to the health care professional.
Confidentiality can be broken when disclosure is essential to avert danger to others.
Remember the Harm Principle...
Confidentiality Case Study
1) Imagine you are the Andre's doctor and he lets you know about his behavior. Apply act & rule utilitarianism. What would each professional do?
2) What would you do in this situation? Why? Draw upon the harm principle & the right to privacy.
3) Should Andre's doctor be held partially to blame in this situation, if the doctor knew but said nothing?
Truth Telling & the Importance of How We Impart Information
1) Discuss the different techniques.
2) Discuss how imparting information in different ways impacts truth telling.
3) Is the doctor "telling the truth" when he rewords the diagnosis in such a way to better impart information?
4) Should doctors always tell the truth? Why or why not.
Don't be like House.
We May Get to the Charlie Gard Case...
1) Should physicians be allowed to refuse to provide treatment (from beneficent motives)?
2) Should parents' autonomy be respected in this instance? (Draw on ethical principles.)
3) Imagine you were the judge ruling on this case. How would you rule, knowing that your ruling has sweeping implications?
What happens when patients want treatment but physicians do not want to provide it?