Breaking bad news - ethical dilemmas for doctors attending to Jewish patients.

FORUM Breaking news to a patient of an illness feared to be serious or life-threatening has always caused difficulties, both moral and ethical, among doctors and all other health care providers. Moreover, there are distinct differences in the approach to this topic among various religious and cultural groups. In any diverse society, such as that in South Africa, it is helpful for doctors to familiarise themselves with the practices and philosophies of various groups, faiths and cultures, in matters relating to life and death. This article attempts to define a Jewish approach, and hopefully create better understanding of the subject among all doctors and health-care providers. (To avoid clumsy repetition, the term 'doctor' will hereafter be used and will denote all health care providers.) Although there has been, in keeping with the culture of an open society, a universal shift towards telling the truth and the right to know, there is still a tendency to withhold the full truth of the ultimate prognosis of an illness. 'Reasons include perceived lack of training [of doctors], no time to attend to the patient's emotional needs, fear of negative impact on the patient, uncertainty about prognostications, requests from family members to withhold information, and a feeling of hopelessness regarding further curative treatment. ' 1 The traditional view among doctors is that most patients do not want to know of the terminal nature of their illness, and have difficulty in coping with the emotional trauma of such disclosures. Psychologists argue that doctors who withhold the truth are actually projecting their own repressed feelings about death, a topic that causes discomfort and is therefore avoided. Alternatively, some feel that the whole truth, and the way it is often disclosed by doctors, can be seen to be insensitive or even brutal, and so lacks compassion and is therefore morally indefensible. The implication is that withholding some of the truth is felt to be justified. In a discourse on contemporary medical practice, Rabbi Immanuel Jacobovits, former Chief Rabbi of the United Kingdom and noted bio-ethicist, stated in the context of imparting bad news that '… we are opposed to divulging the whole truth if there is the slightest suspicion that by doing so, we may cause a physical or mental setback to the patient … peace of mind takes priority over truth, and if necessary, for the sake of the health of the patient, we may play …