ABSTRACT
In the Introduction to the BMA’s practical guide to doctors, Medical Ethics Today, it is said that ‘The fundamental principles observed by the medical profession remain constant but their application to newly evolving situations requires debate’ (BMA 1993: xxiii). Is truthfulness one of these fundamental principles that has always been observed by the medical profession? I have argued that it should be – if we understand truthfulness as a basic commitment not to lie. Yet it is often remarked that honesty, including truthfulness, hardly gets explicit mention in codes or in writings on medical ethics until quite recent times. What has been a constant theme until quite recently is the need for secrecy. The importance of being circumspect about what patients are told, of not disclosing information that might dash hopes, seems a well-entrenched and long-standing tradition. Recall Hippocrates:
Is the current ‘Western’ emphasis on the patients’ right to know something to be explained as an adaptation of long-standing principles to new circumstances? In part, perhaps. Certainly, there are options nowadays that doctors can offer patients which are novel: for example, the possibility of being fed by tube, of resuscitation being attempted, or of donating one’s vital organs when one dies. Patients can only have a say in such matters if they are put in the picture of what may be in store. On the other hand, the choice of whether to tell patients that they are terminally ill is not a new option. Here we might ask whether secrecy was always a mistake, or
whether the ‘Western’ preference for openness with the terminally ill is better in certain sorts of cultures but not necessarily better per se. In this final chapter, I will distinguish what on the matter of ‘truth-telling’ seems to be basic, and fitting for medical practice to observe anywhere, any day, and what is derivative, and fitting for medical practice to observe in some places, at some times.
