The Truth about Truth-Telling in American Medicine: A Brief History

Abstract

Transparency has become an ethical cornerstone of American medicine. Today, patients have the right to know their health information, and physicians are obliged to provide it. It is expected that patients will be informed of their medical condition regardless of the severity or prognosis. This ethos of transparency is ingrained However, for most of American history, the intentional withholding of information was the accepted norm in medical practice. It was not until 1979 that a majority of physicians reported disclosing cancer diagnoses to their patients. To appreciate the current state of the physician-patient relationship, it is important to understand how physician-patient communication has developed over time and the forces that led to these changes. In this article, we trace the ethics and associated practices of truth-telling during -enced physician behavior during that time period. We conclude causing undue harm to their patients.

Why do oncologists hide the truth? Disclosure of cancer diagnoses to patients in China: A multisource assessment using mixed methods

“…This paper is among the first to discover 3 additional barriers for disclosure, specifically, insufficient medical resources and training, patients' financial concerns, and physicians' avoidance of medical disturbance. In fact, the family‐centered disclosure policy in China has persisted primarily because doctors were “prioritizing protective care of cancer patients.” Nevertheless, doctors' “self‐serving reasons” (ie, reluctance to provide emotional support or avoidance of potential conflicts)—which was also documented among American oncologists in the 1980s—may be another dominant reason for nondisclosure in China. Indeed, the extremely high patient‐to‐doctor ratio in China results in inadequate communication between doctors and patients in general .…”

“…(ie, reluctance to provide emotional support or avoidance of potential conflicts)-which was also documented among American oncologists in the 1980s 24 -may be another dominant reason for nondisclosure in China. Indeed, the extremely high patient-to-doctor ratio in China results in inadequate communication between doctors and patients in general.…”

Ethical issues in the care of adolescent and young adult oncology patients

“…Before the 1970s, nondisclosure of a cancer diagnosis was the predominant approach to communication in pediatric and adult oncology . Improvements in treatment options and larger societal shifts led to more transparent communication, initially transitioning from “never tell” to “always tell.” The current literature supports a more nuanced approach that seeks cues from the child or adolescent and meets their individual communication needs. Additionally, current ethical standards strongly discourage intentional deception of any patient, regardless of their age or development.…”

Prognostic Disclosures to Children: A Historical Perspective

“…1 The first American Medical Association (AMA) Code of Ethics in 1847 stated: “A physician should not be forward to make gloomy prognostications because they savour of empiricism… For the physician should be the minister of hope and comfort to the sick.” 2 Given that cancer was essentially terminal, this approach was likely rooted in both concern for the patient’s wellbeing and the physician’s personal discomfort. The code further stated: “The life of a sick person can be shortened not only by the acts, but also by the words or the manner of a physician.” 2 This guarded approach persisted for the next century.…”