Physicians' Attitudes Toward Using Deception to Resolve Difficult Ethical Problems FREE

Dennis H. Novack, MD; Barbara J. Detering, MD; Robert Arnold, MD; Lachlan Forrow, MD; Morissa Ladinsky; John C. Pezzullo, PhD

[+] Author Affiliations

Presented in part at the Ninth Annual Society of General Internal Medicine, Association of American Physicians, American Society for Clinical Investigation, and American Federation for Clinical Research national meetings in Washington, DC, May 3, 1986.

Reprint requests to the Rhode Island Hospital, 593 Eddy St, Providence, RI 02902 (Dr Novack).

JAMA. 1989;261(20):2980-2985. doi:10.1001/jama.1989.03420200070040

Text Size: A A A

Published online

Article

References

ABSTRACT

ABSTRACT | REFERENCES

To assess physicians' attitudes toward the use of deception in medicine, we sent a questionnaire to 407 practicing physicians. The questionnaire asked for responses to difficult ethical problems potentially resolvable by deception and asked general questions about attitudes and practices. Two hundred eleven (52%) of the physicians responded. The majority indicated a willingness to misrepresent a screening test as a diagnostic test to secure an insurance payment and to allow the wife of a patient with gonorrhea to be misled about her husband's diagnosis if that were believed necessary to ensure her treatment and preserve a marriage. One third indicated they would offer incomplete or misleading information to a patient's family if a mistake led to a patient's death. Very few physicians would deceive a mother to avoid revealing an adolescent daughter's pregnancy. When forced to make difficult ethical choices, most physicians indicated some willingness to engage in forms of deception. They appear to justify their decisions in terms of the consequences and to place a higher value on their patients' welfare and keeping patients' confidences than truth telling for its own sake.

(JAMA. 1989;261:2980-2985)

REFERENCES

ABSTRACT | REFERENCES

Connelly JE, DalleMura S. Ethical problems in the medical office . JAMA. 1988;;260:812-815.

Bok S. Lying-Moral Choice in Public and Private Life . New York, NY: Vintage Books; 1978;.

Weir R. Truth telling in medicine . Perspect Biol Med. Autumn 1980;:195-112.

Salzman L. Truth, honesty, and the therapeutic process . Am J Psychiatry. 1973;;130:1281-1282.

Sheldon M. Truth telling in medicine . JAMA. 1982;;247:651-654.

Katz J. The Silent World of Doctor and Patient . New York, NY: The Free Press; 1984;:237-238.

Ad Hoc Committee on Medical Ethics, American College of Physicians . American College of Physicians Ethics Manual. Ann Intern Med . 1984;; 101:129-137.

Novack DH, Plumer R, Smith R, Ochitill H, Morrow GR, Bennett JM. Changes in physicians' attitudes toward telling the cancer patient . JAMA. 1979;;241:897-900.

Goldberg RJ. Disclosure of information to adult cancer patients: issues and update . J Clin Oncol. 1984;;2:948-955.

Faden RR, Becker C, Lewis C, Freeman J, Faden AI. Disclosure of information to patients in medical care . Med Care . 1981;;19:718-733.

Taylor KM, Kelner M. Informed consent: the physicians' perspective . Soc Sci Med. 1987;;24:135-143.

Spring DB, Akin JR, Margulis AR. Informed consent for intravenous contrast-enhanced radiography: a national survey of practice and opinion . Radiology . 1984;;152:609-613.

Guralnick DB, ed. Webster's New World Dictionary . New York, NY: Simon & Schuster Inc Publishers; 1982;:365.

Gilhooly MLM, Berkely JS, McCann K, Gibling F, Murray K. Truth telling with dying cancer patients . Palliative Med . 1988;;2:64-71.

Newall DJ, Gadd EM, Priestman TJ. Presentation of information to cancer patients: a comparison of two centres in the UK and USA . Br J Med Psychol . 1987;;60:127-131.

Givio (Interdisciplinary Group for Cancer Care Evaluation) Italy. What doctors tell patients with breast cancer about diagnosis and treatment: findings from a study in general hospitals . Br J Cancer . 1986;;54:319-326.

Hagman DG. The medical patient's right to know: report on a medical-legal-ethical, empirical study . UCLA Law Rev . 1970;;17:758-816.

Roter DL. Physician/patient communication: transmission of information and patient effects . Md State Med J . 1983;;32:260-265.

Vogel J, Delgado R. To tell the truth: physicians' duty to disclose medical mistakes . UCLA Law Rev . 1980;;28:52-94.

Vanderpool HY, Weiss GB. Ethics and cancer: a survey of the literature . South Med J . 1987;; 80:500-506.

Brody H. Deception in the teaching hospital . Prog Clin Biol Res . 1983;;139:81-86.

Culver CM, Clousner KD, Gert B, et al. Basic curricular goals in medical ethics . N Engl J Med . 1985;;312:253-256.

Figures

Tables

Interactive Graphics

Video

Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal