Institutions have ethical lives and characters just as their individual members do. Health care organizations must look critically at how professed institutional values can best be realized in day‐to‐day interactions within the institution and with the wider community.
This paper examines rationales and policies developed by physicians through history about what to tell patients found to have serious illness. The widespread belief among doctors that the revelation of threatening news causes patients considerable anguish and seriously erodes the prospect of maintaining their hope encouraged a policy of concealment for many centuries. Arguments that encourage candor have been increasingly pressed during the last two centuries. Advocates point out that candor can be beneficial and is favored by many patients, and that a policy of concealment usually fails to work, tends to place stress on patients by constraining discussion of anxieties generated by vague or explicit knowledge of the true situation, and exerts a damaging effect on trust in the medical relationship. Not only the moral aspects of this problem but also its clinical dimensions, such as mastering the skill to discuss threatening news with patients, bear considerable scrutiny by physicians and medical educators.
Reflections about the role of human choice in determining personal health occur in the writings of practitioners and laymen throughout history. THe Greek and Roman writers emphasized the effect of life's activities. During the Middle Ages and Renaissance, disease continued to be seen as a consequence of disorder of the bodily humors, which were under the individual's control. THe rise of the paternalistic national regimes in Europe produced the view that society had the responsibility to maintain health. Jacksonian egalitarianism led to a reaction against the aggressive therapies of established professional experts, a view furthered by the Thomsonian belief that people should wrist control of their health away from orthodox physicians. Among the twentieth century reactions was the movement to urge people to have doctors evaluate laypersons' health. By the 1970s a movement emerged emphasizing again personal responsibility, which, in turn, produced a concern that this was merely "victim-blaming". Views on the role of lay people in determining personal health are heavily influenced by prevailing social, political, and moral climates.
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