Truthfulness, trust and good communication
This chapter covers important issues and relevant clinical situations. It explores the ethical concept of paternalism and how it is balanced with the rights of an autonomous patient, why truth matters, where truthfulness is difficult in everyday medical practice and why doctors lie. Truthfulness is essential to the doctor-patient relationship, and to the trust which patients place in their doctors. The chapter explains the boundaries of clinical discretion to withhold information. It also explores how effective communication can build and maintain trust within the doctor-patient relationship. When a competent patient refuses a medical intervention, against the advice of their doctor, then autonomy is the overriding principle and the paternalistic wishes of the doctor are no longer important. These are the black and white extremes of a broad grey area in which good communication can facilitate a balance between autonomy and paternalism. The principles of autonomy and paternalism are in direct opposition.