On telling dying patients the truth.

a busy outpatient clinic (he gives a horrifying example ofincompetent truth telling); it is an honesty which the patient has sought in the course of psychotherapeutically orientated discussion; it is an honesty which includes continuing support; and it is an honesty which, believes Dr Goldie, reduces unnecessary suffering and helps patients to survive it when it is inevitable. Such views, from a doctor who spends much of his professional life actually talking at length and in depth with patients who are dying deserve very serious consideration. Yet they probably represent a small minority of medical opinion on thNs issue. More commonly in practice if not in print doctors tend to deceive patients with fatal diseases (especially cancer) about both diagnosis and prognosis. Three arguments defending such deception are often heard. The first is that the doctor's primary moral obligation is not to harm his, or her, patient (primum non nocere) and that this obligation over-rides the requirement not to deceive: fatally ill patients already have enough problems oftheir own without the doctor harming them further by telling them that they have cancer and will probably soon die from it. The second argument against truth telling is that the doctor can never be sure of the diagnosis or prognosis and in any case patients have not been trained to understand the truth even if they are told it: patients have insufficient comprehension of the intricacies of medicine; of the enormous variety of conditions encompassed by the word 'cancer'; of the range of possible outcomes; of the pros and cons of various treatments, and thus, even ifone wants to, it is usually impossible successfully to communicate the truth. An American physician combined these two arguments long ago when he wrote: 'it is meaningless to speak of telling the truth, the whole truth and nothing but the truth to a patient. It is meaningless because it is impossible . . . far older than the precept "the whole truth and nothing but the truth" is another that originates within our profession, that has always been the guide of the best physicians and if I may venture a prophecy will always remain so:"so far as possible do no har... ." (i). The third argument against truth telling is that patients do not wish to be told the truth when they have