Truth-telling in the doctor–patient relationship: a case analysis

Using a real-life case involving an accidental discovery of misattributed paternity as a springboard for discussion, I reflect on several practical and theoretical issues on truth-telling in the doctor–patient relationship. I present the moral dilemma and identify arguments in favour of and against disclosure. I then examine the theoretical difficulties in balancing conflicting reasons and in establishing what constitutes the ‘truth’. I conclude that withholding the information from the patients would be ethically permissible and, more generally, that honesty is not always the best policy. Clinical Ethics 2006; 1: 000–100 Daniel Sokol’s background is in linguistics, medical history and medical ethics, and he has recently submitted his PhD on the ethics of truthtelling and deception in the doctor–patient relationship. He has coauthored a textbook on medical ethics and law (Medical Ethics and Law: Surviving on the Wards and Passing Exams, Trauma Publishing, 2005) and has published widely on clinical ethics both in academic journals and in popular outlets. He is currently interested in the establishment of clinical ethics support services in British hospitals and has worked as an intern in clinical ethics in hospitals in Canada and the US. Outside ethics, Daniel is a keen magician and is the volunteer magician at Charing Cross Hospital, London. Introduction This case, based on a real case published in the journal Seminars in Dialysis in 2002, illustrates the fascinating complexity of doctors’ decisions to disclose information. I will use it as a springboard to discuss several practical and theoretical issues relating to truth-telling in the doctor–patient relationship.