Mapping the Moral Terrain of Clinical Deception.

Tytuł:: Mapping the Moral Terrain of Clinical Deception.
Autorzy:: Brummett A
Salter EK
Źródło:: The Hastings Center report [Hastings Cent Rep] 2023 Jan; Vol. 53 (1), pp. 17-25.
Typ publikacji:: Journal Article
Język:: English
Imprint Name(s):: Publication: 2012- : Malden, MA : Wiley-Blackwell
Original Publication: Hastings-on-Hudson, N. Y., Institute of Society, Ethics and the Life Sciences.
MeSH Terms:: Deception*
Morals*
Humans
References:: D. Oken, “What to Tell Cancer Patients: A Study of Medical Attitudes,” Journal of the American Medical Association 175 (1961): 1120-28.; D. H. Novack et al., “Changes in Physicians’ Attitudes toward Telling the Cancer Patient,” Journal of the American Medical Association 241 (1979): 897-900.
Canterbury v. Spence, 464 F.2d. 772 (D.C. Cir. 1972).
L. S. Sulmasy and T. A. Bledsoe, “American College of Physicians Ethics Manual,” supplement, Annals of Internal Medicine 170 (2019): S1-S32.; American Medical Association, “Withholding Information from Patients,” opinion 2.1.3, Code of Medical Ethics, AMA, 2016, https://code-medical-ethics.ama-assn.org/ethics-opinions/withholding-information-patients.
N. N. Dubler and C. B. Liebman, Bioethics Mediation: A Guide to Shaping Shared Solutions (Nashville, TN: Vanderbilt University Press, 2011); M. Williams, D. McGuire, and M. Rizzo, eds., Practical Ethics in Clinical Neurology: A Case-Based Learning Approach (Philadelphia: Wolters Kluwer Health/Lippincott, Williams, & Wilkins, 2012).
D. K. Sokol, “Can Deceiving Patients Be Morally Acceptable?,” BMJ 334 (2007): 984-86.; C. Richard, Y. Lajeunesse, and M. T. Lussier, “Therapeutic Privilege: Between the Ethics of Lying and the Practice of Truth,” Journal of Medical Ethics 36, no. 6 (2010): 353-57.
B. Freedman, “Offering Truth: One Ethical Approach to the Uninformed Cancer Patient,” Archives of Internal Medicine 153, no. 5 (1993): 572-76.
Sokol, “Can Deceiving Patients Be Morally Acceptable?,” 985.
Richard, Lajeunesse, and Lussier, “Therapeutic Privilege,” 355.
T. Beauchamp and J. Childress, Principles of Biomedical Ethics, 7th ed. (New York: Oxford University Press, 2013).
B. Lo, Resolving Ethical Dilemmas: A Guide for Clinicians, 5th ed. (Philadelphia: Wolters Kluwer Health/Lippincott, Williams, & Wilkins, 2013), 54.
Ibid., 56.
J. Sheather and T. Shah, “Ethical Dilemmas in Medical Humanitarian Practice: Cases for Reflection from Médecins sans Frontières,” Journal of Medical Ethics 37, no. 3 (2011): 162-65.
Sokol, “Can Deceiving Patients Be Morally Acceptable?,” 984-86.
T. Moncur and A. Lovell, “The Therapeutic Lie: A Reflective Account Illustrating the Potential Benefits When Nursing an Elderly Confused Patient,” Australian Nursing and Midwifery Journal 25, no. 7 (2018): 37.
An additional way in which beneficence-based justifications may vary is based on whose benefit or harm is being achieved or avoided. While typically the person of interest is the patient, the benefits or harms of others may also be relevant to justifying an act of deception, as is captured in example 2b in the table.
Sokol, “Can Deceiving Patients Be Morally Acceptable?,” 985; Richard, Lajeunesse, and Lussier, “Therapeutic Privilege,” 356.
W. S. Andereck, “Development of a Hospital Ethics Committee: Lessons from Five Years of Case Consultations,” Cambridge Quarterly of Healthcare Ethics 1, no. 1 (1992): 41-50.
J. T. Fortunato, J. A. Wasserman, and D. L. Menkes, “When Respecting Autonomy Is Harmful: A Clinically Useful Approach to the Nocebo Effect,” American Journal of Bioethics 17, no. 6 (2017): 36-42.
A. Brummett et al., “We have nothing left to bury,” Hastings Center Report 52, no. 1 (2022): 12-14.
R. R. Faden and T. L. Beauchamp, A History and Theory of Informed Consent (Oxford: Oxford University Press, 1986).
L. F. Ross, “What the Medical Excuse Teaches Us about the Potential Living Donor as Patient,” American Journal of Transplantation 10, no. 4 (2010): 731-36.
J. D. Lantos and W. L. Meadow, “Should the ‘Slow Code’ Be Resuscitated?,” American Journal of Bioethics 11, no. 11 (2011): 8-12.
Dubler and Liebman, Bioethics Mediation, 216.
See Catholic Church, Catechism of the Catholic Church, 2nd ed. (Washington, DC: United States Catholic Conference, 2011), which states, “Scandal is an attitude or behavior which leads another to do evil” (sec. 2284), and, “Anyone who uses the power at his disposal in such a way that it leads others to do wrong becomes guilty of scandal and responsible for the evil that he has directly or indirectly encouraged” (sec. 2287).
Contributed Indexing:: Keywords: clinical deception; clinical ethics; doctor-patient relationship; therapeutic privilege; truth telling; veracity
Entry Date(s):: Date Created: 20230225 Date Completed: 20230228 Latest Revision: 20231116
Update Code:: 20240105
DOI:: 10.1002/hast.1454
PMID:: 36840331
: Czasopismo naukowe

Pełny tekst

Legal precedent, professional-society statements, and even many medical ethicists agree that some situations may call for a clinician to engage in an act of lying or nonlying deception of a patient or patient's family member. Still, the moral terrain of clinical deception is largely uncharted, and when it comes to practical guidance for clinicians, many might think that ethicists offer nothing more than the rule never to deceive. This guidance is insufficient to meet the real-world demands of clinical practice, and this article endeavors to articulate a framework to help clinicians better navigate the ethics of clinical deceit. The framework articulates four morally relevant dimensions of a potential deceptive act that should be examined to better determine the moral justification that might be required: the target of the act, the nature of the information, the nature of the act, and the context of the act.
(© 2023 The Hastings Center.)

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