The two approaches namely adherence to a formula and so far as possible, do no harm in Bernard Meyers’ “Truth and the Physician,” highlights on extremely crucial aspect in the medical fraternity. Meyer’s meaning is convoluted in the sense that the relationship between doctors and patients remain unclear. The meaning of his two approaches is that lying and withholding the truth is likely to help both the doctor and the patient. This is because on one hand doctors are required to stick to their ethical codes of conduct and on the other hand, do no harm to the patient. In cases when a doctor deems lying as the only way, it is not appropriate to disclose the truth to the patient as it may make their prognosis worse. Philosophically, Meyer’s approaches are extremely interesting since they highlight on the apprehension linking non-malfeasance and the prima facie, which is the unfairness in truth revelation (Meyer 77).
First and foremost, doctors when assuming their duties they swear to do no harm, which is the principle of non-malfeasance. In reality, there are numerous cases wherein telling the truth would for instance truly harm the patient for instance by lowering his will of fighting his/her disease. It is essential for doctors to consider the feelings of the patient’s family, patient, and other people who are related to the ailing person. Conversely, there is the side known as prima facie which refers to the wrongness in lying but, all together, the principle of non-malfeasance states that doctors should lie (Meyer 172). This is the reason why the two approaches are complex; therefore, one may argue that Meyer uses one approach to ascertain that giving bad news is difficult.
Actually, emotional reactions and the correspondent reason that pushes people to enter in the medical profession are based on three categories namely, rescue fantasy, reaction formation, and counter-phobia. To begin with, rescue fantasy implies that doctors enter the profession purposely to save people’s lives. In cases whereby a person enters the medical profession and fails to save people’s lives, they always feel worthless. Secondly, doctors enter the profession because they are fighting their previous impulses to wound and to destroy. In this regard, telling a patient that we are just trying buy you will die anyway makes doctors feel guilty or wicked. Thirdly, counter-phobia implies that medical practitioners or doctors enter the profession to fight their own fear of sickness and dying. For instance when he/she is forced to tell the truth concerning individual’s death or just any bad news, they usually feel personally responsible. All these reasons provide the ground as to why it is difficult for doctors to tell the truth, bad news. Nonetheless, these reasons do not provide ethical validation for lying to patients. The doctors are in dilemma on what to do. Meyer believes that most doctors in reacting to difficulties mentioned above adopt inflexible convention concerning the revelation of truth to the patients. To this point, some doctors choose to never tell the truth while others choose to always tell the truth. Meyer after confronting all these issues believes that the best way to solve such problems is by avoiding rigid rules regarding disclosure of the truth to the patients.
For example, following hospitalization of my mother, I realized that in life things happen for different reasons. In my case, I came to learn many things when my mother became sick. I was only ten years old, my mother became hospitalized and I was in the care of a babysitter. This was the moment I realized that life has numerous tests. During this period my father worked over-time and weekends, so the babysitter would take me to her house and fortunately or unfortunately that was where we lived with my sister. My sister studied a major in Business Administration; however, following our mothers illness, she suddenly changed her mind and decided that she wants to join the medical profession citing the reason that Meyer refers to as rescue fantasy. Doctors never told us about the disease our mother suffered from. Although I was young then, I later came to realize why everyone never got this crucial information. My dad had difficult time looking for finances to cater for my sister’s education since she had completely changed her mind. Later on, my mum left the hospital with some medication with the hopes that she will soon get well. As I grew old enough to realize what was going on, I came to realize that my dad had been told about the chronic disease my mother had to succumb to. My dad was told at a later stage when nothing could actually be done. I came to learn that my mum was suffering from Chronic Obstructive Pulmonary Disease (COPD) and Cancer, which some of the most dangerous diseases. When finally my mum succumbed to these chronic diseases, we had used all the available resources.
I suppose that this is why Meyer highlights on the difficulty with the rigid approaches that do not recognize differences among individuals. He therefore recommends the decision relating to disclosure of any information to patients should be personalized by taking into consideration the psychologies and needs of patients. The decision should not be subject to dictation of inflexible guidelines. Still, the two approaches some complexities since what we are referring to as the “truth” is not always clearly defined and this is why it cannot always be presented to the patient. For example, there are some conditions or chronic diseases that are terminal today but tomorrow might have available treatments. This makes it difficult for the doctor to provide a clear counsel. In addition, human beings are bound to making mistakes and doctors are no exception, however, mistakes in such grave situations could have serious consequences. To this end, Meyer believes that doctors should not always present the truth.
To some extent, one may feel that adhering to the truth, bad news is helpful. However, patients may also ask for the truth while in reality, they do not want it. What the patients may consider vital is the confidence that they are being told the truth, while consequently being given good news. Therefore, the doctor cannot offer patients the truth (bad news). This is because powers of self-deceptions are really powerful. This is the tendency of underestimating the individual’s discernment. For instance, a parent who explains to his/her children issues regarding sex. One parent may feel that the parent who explains sex to the children is misleading them while the other may treat it as a normal thing. This is usually based on the perception of every parent. Medical professionals do not consider underestimation since it is likely to cause severe consequences to the patient. For example, one may not tell what the patient thinks regarding his/her situation and when an environment of anxiety or distrust is created, patients may develop a scenario that is far worse than the actual one.
As much as patients have their basic rights regarding the truth about their diagnosis, prognosis, and available treatments; the medical profession is not yet ready to tell the truth. This is why many people seek to know when the doctors should actually tell the truth because the idea of patients’ rights might incline the doctors to adhere to a firm formula. Bernard Meyer explains that adherence to a formula allows physicians to “abandon personal judgment and authorship in his discourse with his patients,” (166). Certainly, the strict adherence to a formula to providing relevant information to patients is likely to eliminate the difficult process of decision-making on when to tell the truth (Thomas, and James 77). In this case, decision-making would be quick. On the contrary, the strict formula might be to always never tell the truth maybe because of the psychological makeup of certain patients. This psychological makeup may also bur doctors from revealing the truth. In both cases, strict rules makes it impossible for patients to be engaged in the decision making process. In most instances, before a doctor meets a patient, he always decides in advance what he is likely to do in case the patient’s condition gets worse or fall (Thomas, and James 38). According to Meyer, a strict formula approach to telling the truth is as a result of motivation from abstract ethical guidelines such as “always tell the whole truth.” In the medical field there is very little truth. Many people would therefore argue that medical professionals disregard their moral duties by seeking to fulfill ‘so far as possible, do no harm’. This is because in certain cases, the effects of telling the truth can be harmful to the patient. In such cases, it is arguably vital to withhold the truth from patients if it is in their best significance.
I would prefer the second approach because of numerous reasons. One, I would say that denial or repression as powerful tools of deception can be used by the patients to avoid coming into terms with their conditions. In the same way, they are the same tools that the doctors can use to deny the patients the truth. Secondly, doctors or the medical professionals are not ready to tell the truth to their patients. Although, this does not imply that they don’t have to tell the truth, but rather a better way of dealing with the situation without hurting the patients emotionally or psychologically. Another reason why I believe in so far as possible, do no harm is because I feel that the decision should be based on individual and rigid rules for disclosure should be avoided. This appears the most appropriate approach since the patient is given the opportunity to determine whether he/she gets the crucial information, the truth. As much as the decision should squarely lie on the hands of the patient and next of kin, this is likely to make the prognosis even worse. For example, looking at the example I gave in the fourth paragraph, it is clear that if a patient has slim chances of survival then it is vital to consider the psychological effects. This must reflect on the psychological makeup of the patient. Provided the psychosomatic effect, the potential for a patient to suffer most because of mental disturbances is relatively low. This is because doctors merely anticipate that patient’s prognosis is likely to worsen.
Conversely, if the chances of survival are high, for example 75%, then the second option still remains the most applicable (Broke 238). This is because the patient will be motivated to fight the disease while at the same time maintaining a positive mental attitude. The second approach is the best because withholding the truth from the patient in most instances is likely to act as a therapeutic measure. Even in cases when the condition is terminal, withholding the truth still plays an integral role in avoiding the depression and effects as a result of anxiety. Without telling the truth allows them the chance of living a peaceful and happy life because they have nothing to worry about. To this end, therapeutic privilege is basically a good reason for doctors to either lie to patients or withhold the truth (bad news) from them (Meyer 184). Everyone may have his/her own opinion since people have divergent views, however, I believe that doctors should stick to the so far as possible, do no harm approachsince it acts as a therapeutic measure to the patients. Finally, it also does not expose patients to psychological stress and anxiety. However, patients must also receive their privilege of exercising their basic rights concerning the truth about their diagnosis, prognosis, and available treatments (Broke 258). This will in the long run help them determine the way forward, whether to continue spending or stop spending on a condition that its chances of survival are slim. The second approach remains the most important of the Hippocratic maxims.