The 19th century philosopher Henry Sidgwick argues in The Methods of Ethics that deception is “sometimes right” when it is “designed to benefit the person who is deceived” [1]. In medicine, benevolent deception is the process by which patients are misled by doctors in an effort to prevent possible negative effects from the disclosure of their diagnoses. Defenders of the practice argue that life-altering information, particularly when dealing with death, can cause anxiety and eliminate hope [2]. However, benevolent deception in the medical profession violates the fundamental duty of truthfulness in healthcare, promotes a patient-doctor relationship characterized by paternalism, and infringes upon the autonomy of the patient.
18th century writer Samuel Johnson denies the “lawfulness” of “telling a lie to a sick man” [1]. He argues that a doctor has “no business” with the “consequences” of disclosing information and is to only tell the truth [1]. At its root, withholding information, whether minor or life-changing, is a form of lying. The job of the medical professional is not to guess how a patient will react to information, but rather to explain, in full, the implications of a diagnosis and to discuss the best ways to move forward. The American Medical Association’s Principles of Medical Ethics obligates physicians to be “honest in all professional interactions” [2]. Allowing for deception in medicine is a slippery slope that can lead to widespread suspicion of information given by physicians, and, as a result, strained patient-doctor relationships. A vital aspect of putting a patient first is treating them as worthy of and entitled to the facts pertaining to their own health. The ultimate duty of a medical provider to tell the truth should be at the forefront of the conversation since candor builds trust, which is essential to the patient-doctor dynamic.
The patient-doctor relationship can be described in many ways. Some describe the ideal relationship as a partnership in which the patient and doctor work together towards healing.³ Others describe it as a negotiation that is fostered through communication and compromise.³ The practice of benevolent deception, however, breeds a paternalistic patient-doctor relationship that results in a condescending power dynamic not conducive to the free flow of questions, advice, and information.
Paternalism is especially evident in the case of Henrietta Lacks. Lacks was a thirty-year-old African American woman living at a time when hospital wards were segregated. Throughout the duration of her illness, Lacks’ doctors consistently kept her in the dark when it came to the details and severity of her diagnosis. By denying her the information about her condition, doctors dehumanized Lacks. In addition to failing to disclose details of her illness, doctors conducted research on her cells without her consent. They treated her as a lab subject to be experimented upon rather than a person with beliefs, dreams, aspirations, and agency. While Lacks’ children were grasping for closure after Lacks’ death, biomedical companies were profiting off of their mother’s cells. HeLa cells have been instrumental in the development of the polio vaccine, used to test the efficacy of anti-tumor medications, and have furthered understanding of diseases such as HIV/AIDS. However, it was not until years after Henrietta’s death that her family learned of the experimentation by accident. From their understanding, the experimentation on her cells caused her pain even after her passing. A number of racial and socioeconomic factors played into Lacks’ story, but patterns of deception and disregard for agency are especially prominent.
By definition, autonomous individuals “act intentionally, with understanding, and without controlling influences” [4]. Benevolent deception can infringe upon the autonomy of patients by preventing them from making informed choices in regards to their own health. In The Principles of Medical Ethics, Beauchamp and Childress note that autonomy is a positive obligation that requires professionals in healthcare to “disclose information” in order to “foster adequate decision making.” [2]. The patient should be the primary judge of his or her own body and thus information about his or her wellness should be shared in a prompt and comprehensive manner. As the ultimate decisionmakers over their own bodies, patients cannot consider courses of action if they are not told exactly the condition they are in.
Imparting disheartening and life-changing news to patients can cause them a great deal of worry and apprehension. However, patients are entitled to knowledge about their well-being, and denying or impeding it undermines their autonomy. Ultimately, the job of the doctor is to explain all aspects of the diagnosis and to work with the patient towards the shared goal of health.
References
Sidgwick, Henry. “The Methods of Ethics”, 1874. https://www.laits.utexas.edu/poltheory/sidgwick/me/me.b03.c07.s02.html.
Beauchamp, Tom L., and James F. Childress. “Principles of Biomedical Ethics”, 7th ed., Oxford University Press, 2009.
Childress, James and Siegler, Mark. “Metaphors and Models of Doctor-Patient Relationships: Their Implications for Autonomy”, 1984.
Pantilat, Steve. “Autonomy vs Beneficence”, University of California San Francisco, 2008,missinglink.ucsf.edu/lm/ethics/content%20pages/fast_fact_auton_bene.htm