Lying to a Dying Patient

In an intensive care unit at Boston and Brigham and Women’s Hospital, a terminally ill patient in the end stage of cancer asked Dr. Daniela Lamas to be removed from machines and tubes so he could go home.

“I have to leave,” the patient pleaded, Lamas reports in The New York Times. “Let me go.” The patient struggled to get out of bed, pulling on lines inserted into his body.

“I wish there was something we could do, but the cancer is too advanced. You’re dying,” Lamas told him.

Lamas continued to report: “I spoke loudly so he could hear me despite the mask. He turned his head away, as if to avoid my words. I pressed on. 'It could be hours now. I don’t think you will make it through the night.'”

A couple of weeks later, every letter to the editor to the Times was about Lamas's article, with opinions ranging from the patient has the right not the know to tell the patient the truth.

No wonder such interest. Today, 60% of Americans will die in acute care hospitals under the supervision of someone in the health care industry.

A doctor's commitment to "do no harm"

I have been on the ethics committee of a major hospital on Long Island for nearly 30 years. Most cases that the committee deals with center around end-of-life matters when patients can no longer speak for themselves and there is no health care proxy or when there are disagreements between family members and doctors about whether to discontinue treatment.

A core mandate of medicine is to do no harm. However, this often runs into the ethical principle of patient autonomy. The conflict sometimes arises when a patient or surrogates want everything possible to be done to prolong the patient’s life when, in fact, doing so would be medically futile. It can also arise when a patient wants to leave but doing so is impractical.

Talking to dying patients is the role of hospital chaplains, psychologists, or social workers, but the reality is that often a patient last speaks to a doctor who is attending to the treatment, a person skilled in medicine but rarely taught how to convey hard news.

Lamas looks back on her experience with the terminally ill patient and wishes she had lied to him to soothe his anguish. Many support this view. What good is telling the truth when it creates psychic harm? When no more can be done to prolong the patient’s life, the doctor’s role now becomes "do no harm." Not only does telling the truth do no good, so the argument continues, but it in fact also does harm.

Others argue that by telling the truth, patients and families have the opportunity to say their final good-byes and make appropriate plans. What’s more, some say, lying runs contrary to the ethical dictum of respect for persons. It is an assault upon their integrity.

The importance of trust

There is a larger concern, I believe. In a time in which false information is rife and expert opinion is under attack (not just in the political sphere), it is essential that doctors provide as much accurate information as possible. To cherrypick when to be honest will only further erode what trust there is in the profession and further open the way for charlatans and unscrupulous businesses to take advantage of people and undermine public health.

The problem with lying is that it ultimately erodes trust, the very foundation of society. While today Lamas wonders whether she should have lied to the patient, what would it be like if you couldn’t trust your doctor’s word? Why would you believe a diagnosis, why submit to a treatment, why take expensive medications, why not get your medical advice from your neighbor or the internet if you didn’t believe that your doctor wasn’t telling you the truth?

Unfortunately, we aren’t far from that situation right now. One way to retrieve the critical doctor-patient relationship, I believe, is by physicians being truthful to patients, even—perhaps especially—in difficult circumstances.

Does this mean being hurtful? I don’t think so. There is always a way to tell the truth without being brutal. Deception can be an easy way out. But in the long run, it is self-defeating. For the sake of future patients and the integrity of the medical profession, doctors need to learn the skill of telling the truth without doing harm.