What are some reasons for withholding information from patients? Cite examples from the Being Mortal film and/or, other readings/media.
What is your personal opinion on veracity (disclosure and/or paternalism) in health care?
How can advanced care planning and serious illness care conversations decrease bioethical end-of-life dilemmas?
Incorporate tenets/principles/beliefs from the Code of Ethics in Nursing and how this was involved in your decision-making, how do these empirical concepts or perceptions impact your view regarding the disclosure of health care information and end of life care.
Sample Answer
The tension between transparency and the desire to protect a patient from distressing news is a central theme in end-of-life care. This conflict often pits the principle of autonomy against beneficence (acting in the patient's best interest).
1. Reasons for Withholding Information
Historically, "therapeutic privilege" allowed clinicians to withhold information if they believed disclosure would cause "serious psychological harm." While modern medicine favors transparency, information is still frequently withheld or "diluted" for several reasons:
Avoidance of Despair: As seen in the film Being Mortal, Dr. Atul Gawande notes that doctors often struggle to give "the hard talk." They may withhold the terminal nature of a diagnosis to maintain a patient's "hope," even when that hope is statistically improbable.
Medical Paternalism: Some clinicians believe they are protecting the patient from the "burden" of a terminal prognosis, assuming the patient lacks the fortitude to handle the truth.
Cultural Nuance: In some cultures, it is considered disrespectful or "bad luck" to speak of death directly. Families may request that the doctor withhold a cancer diagnosis from an elderly relative to preserve their peace of mind.