Doctors shouldn’t lie to their patients, even now when the parsing of words and the telling of white lies is common at the highest level of our government. But they do it all the time — sometimes for personal reasons but most of the time for what they believe is the good of their patients.
As a neonatologist and a pediatric cardiologist, we know that truth and honesty are key parts of the foundation of the doctor-patient relationship. “Commitment to honesty with patients” is a primary responsibility for physicians set out in the Charter on Medical Professionalism.
Yet physicians — including us — do lie.
We have said to parents of newborns, “She will sleep through the night,” or, “Your breast milk will come in any day now,” knowing there is a distinct possibility that neither might happen.
We have said to parents with children in the cardiac intensive care unit, intubated and sedated after major heart surgery, “He isn’t in pain; he knows that you’re here,” when we have little idea whether such awareness is possible in states of induced coma and paralysis.
We have said to parents whose infant has features of a lethal genetic abnormality, “She is beautiful and perfect,” when there is nothing else to say.
And we have said to parents who desperately rushed to their dying baby’s bedside, “He is still here,” while placing him in their arms and shutting off the monitor so they can’t see that his heart is no longer beating.
We tell these untruths not to deceive parents, but to offer words that lighten their hearts in moments of despair. We do it, we tell ourselves, to spare their feelings.
But perhaps we sometimes lie for our own sake, and it is our feelings that need to be spared so we can get through the night without breaking down in the call room when all signs indicate the outcome will not be good.
The dilemma is not new.
In 2012, a nationwide survey showed that one-third of the 1,981 physicians sampled said they should not necessarily share serious medical errors with their patients. Two-fifths of the doctors did not disclose their financial relationships with drug and device companies to patients. These sorts of lies are clearly harmful and transparency is necessary.
Some physicians lie to third-party payers to obtain approval for treatments or procedures their patients need. Their willingness to deceive payers varies by disease severity: 58 percent said they would do this for coronary bypass surgery and 35 percent for screening mammography, but just 2.5 percent for cosmetic rhinoplasty — a nose job.
In an imperfect health care system limited by resources, the morality of whether physicians should advance what they believe is in the best interest of their patients above and beyond existing rules and regulations can be debated.
Yet white lies are also problematic. Medical ethicists have argued for decades on the moral distinction between lying and deception, and physicians have long struggled with absolute honesty versus withholding dismal facts.
One study found that more than 55 percent of physicians sometimes or often described a patient’s prognosis in a more positive manner than the facts support. A deception flowchart has been developed to help doctors “who are not absolutist” decide when it is morally acceptable for them to deceive patients.
In reality, the flowchart, or saying “I don’t know,” doesn’t always help. And being brutally honest doesn’t always help families make decisions or guarantee the preferred outcome. We could — and should — dutifully cite statistics of morbidities and mortality to families, such as, “Your child has a 60 percent chance of survival.” As physicians, we may feel that at least they heard the numbers. But for families, survival is a dichotomous yes or no. Giving hope and sometimes describing a prognosis in a more positive manner than the facts might support is the reality of what physicians do.
To be sure, deception that limits an individual’s or a parent’s ability to make informed decisions is reprehensible. Sugar-coating devastating results, or making light of grave situations as if there will be meaningful recovery is also wrong. Patients and their family members must be told results and expectations based on experience and evidence, as honestly and as clearly as a clinician can. But the art of medicine calls upon us to be nuanced and possibly shield them from unnecessary pain.
The foundations of a doctor-patient relationship can remain strong even with “white lies,” as long as our actions are grounded in kindness and we are doing our best for our patients in difficult times.