In this first essay of the new year, I thought I would dedicate a few paragraphs to the ethics of truth-telling in procedural medicine. From the time they are medical students, doctors are burdened by decisions of what to say and how much to share with patients. The range of topics for which these decisions apply is extensive. These extend from revealing the extent of one’s own experience to discussing complications, obtaining valid informed consent, revealing medical error, and sharing diagnostic findings, prognosis, and the likelihood of cure or treatment failure.
The ethical space truth-telling occupies in procedural medicine is especially complex because physicians often find themselves incorporating infrequently practiced or newly learned procedures into their interventional practices. From the time one performs their first blood draw or lumbar puncture to one’s first attempts to perform a complex airway procedure, the questions are the same. How should physicians answer their patients’ queries regarding the extent of their experience? What must they share about the extent of their patient’s disease and diagnosis? What do they say (and to whom) if something goes wrong? How and when do they involve their patients’ family members, and how much personal opinion versus facts should they share about presumptive diagnoses and prognosis?
It is no surprise that the ethical obligation to tell the truth: to disclose risks, alternatives, limitations, and uncertainties, remains foundational in virtually every medical cultural environment. In this sense, truth-telling is not only legally required but also a moral obligation rooted in the ethical principle of respect for autonomy and the preservation of human dignity.
The devil, of course, is in the details. For example, is a doctor’s failure to tell a patient this is their “first time performing the procedure independently” any different from exaggerating about their level of experience? Is a physician’s desire to simplify, soften, or selectively emphasize certain information a form of coercion, a benevolent attempt to reduce anxiety and facilitate consent, or a subconscious effort to frame discussions in ways that conform with institutional norms or personal goals and values that might differ from those of their patients?
From an ethics perspective of justice, truth-telling in procedural medicine cannot be separated from notions of equity, power, and access to understanding. Patients do not enter procedural encounters on equal footing with their health care providers. They are not only at a disadvantage due to illness-induced vulnerabilities. They are also affected by disparities in health education, socio-economic status, language fluency, healthcare literacy, and cultural biases regarding whether and how to question a physician’s experience and authority. To complicate matters further, procedural risks are probabilistic and often context-dependent. The ethical weight of truthful disclosure in these settings is therefore especially pronounced.
Many other aspects of care related to telling the truth warrant discussion. In this short essay, I simply suggest that truth-telling in procedural medicine occupies a central place surrounded by the triumvirate of clinical uncertainty, technical expertise, and patient vulnerability. Physicians who navigate these unsteady waters can be guided, however, by their personal integrity, a profound respect for their patients’ moral agency, and a steady commitment to medical professionalism regardless of institutional and societal pressures.
- Beauchamp TL and Childress JF. Principles of Biomedical Ethics. 8th ed. Oxford University Press, 2019.
- O’ Neill O. Autonomy and Trust in Bioethics. Cambridge University Press, 2002.
- Sheldon M. Truth-telling in medicine. JAMA. 1982 Feb 5;247(5):651-4. PMID: 7054566.