Abstract
Searight and Meredith review the ethical, clinical, legal, and cultural aspects of deliberate non-disclosure of medical “bad news.” The chapter explains how US norms for physicians’ communication of life-threatening illness to patients have changed over the past 60 years. The authors also discuss how cultural dimensions play a significant role in the disclosure of serious medical conditions. Further, the chapter examines historical examples of physicians writing for the general public and defending non-disclosure, thereby misleading patients that such practices are compassionate and a medical virtue. Searight and Meredith trace the gradual evolution of the norm of patient informed consent from the 1930s to the present and argue that withholding medical “bad news” continues to be a value in some collectivist cultures.
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Alexander, S. (1962). They decide who lives, who dies. Life,53, 102–125.
Baile, W. F., Buckman, R., Lenzi, R., Glober, G., Beale, E. A., & Kudelka, A. P. (2000). SPIKES—A six-step protocol for delivering bad news: Application to the patient with cancer. Oncologist,5, 302–311.
Beauchamp, T. L. (2011). Informed consent: Its history, meaning, and present challenges. Cambridge Quarterly of Healthcare Ethics,20(4), 515–523.
Beauchamp, T. L., & Childress, J. F. (1979). Principles of biomedical ethics. New York: Oxford University Press.
Beauchamp, T. L., & Childress, J. F. (2009). Principles of biomedical ethics (6th ed.). New York: Oxford University Press.
Beauchamp, T. L., & Childress, J. F. (2013). Principles of biomedical ethics (7th ed.). New York: Oxford University Press.
Beecher, H. K. (1966). Ethics and clinical research. New England Journal of Medicine,274, 1354–1360.
Bellah, R., Madsen, R., Sullivan, W., Swider, A., & Tipton, S. (2007). Habits of the heart. Berkeley: University of California Press.
Blackhall, L. J., Murphy, S. T., Frank, G., Michel, V., & Azen, S. (1995). Ethnicity and attitudes toward patient autonomy. Journal of the American Medical Association,274, 820–825.
Blease, C. (2015). Authorized concealment and authorized deception: Well-intended secrets are likely to induce nocebo effects. The American Journal of Bioethics,15, 23–25.
Boulware, L. E., Cooper, L. A., Ratner, L. E., LaVeist, T. A., & Powe, N. R. (2003). Race and trust in the health care system. Public Health Reports,118, 358–365.
Boulware, L. E., Ratner, L. E., Cooper, L. A., Sosa, J. A., LaVeist, T. A., & Powe, N. B. (2002). Understanding disparities in donor behavior: Race and gender differences in willingness to donate blood and cadaveric organs. Medical Care,40(2), 85–95.
Bowen, O. R. (1954, February). Should patients be told when diagnosis is cancer? Time, 15, 71–72.
Buckman, R. (1984). Breaking bad news: Why is it still so difficult? British Medical Journal,288, 1587–1589.
Callahan, D. (1992). When self-determination runs amok. Hastings Center Report,22(2), 52–55.
Candib, L. (2002). Truth telling and advance planning at the end of life: Problems with autonomy in a multicultural world. Families, Systems, and Health,20, 213–228.
Carrese, J. A., & Rhodes, L. A. (1995). Western bioethics on the Navajo reservation. Journal of the American Medical Association,274, 826–829.
Chester v. Afshar. (2005). 1 AC 134, para 50, per Lord Hope.
Collins, J. (1927). Should doctors tell the truth. Harper’s,155, 320–326.
Edelstein, L. (1967). The Hippocratic Oath: Text, translation and interpretation. In O. Temkin & C. L. Temkin (Eds.), Ancient medicine: Selected papers of Ludwig Edelstein (pp. 3–64). Baltimore: Johns Hopkins University Press.
Eisenberg, D. J. (1986). The change in physicians’ attitudes towards truth-telling and to dying patients: 1920s–1980s. D. J. Eisenberg Publisher.
Epstein, R. M., Korones, D., & Quill, T. E. (2010). Withholding information from patients—When less is more. The New England Journal of Medicine, 362, 380–381.
Epstein, R. M., & Peters, E. (2009). Beyond information: exploring patients’ preferences. Journal of the American Medical Association,302, 195–197.
Everett, J. P., Walters, C. A., Stottlemyer, D. L., Knight, C. A., Oppenberg, A. A., & Orr, R. D. (2011). To lie or not to lie: Resident physician attitudes about the use of deception in clinical practice. Journal of Medical Ethics,37(6), 333–338.
Faden, R., Beauchamp, T., & King, N. M. P. (1986). A theory and history of informed consent. New York: Oxford University Press.
Feagin, J., & Bennefield, Z. (2014). Systemic racism and US health care. Social Science and Medicine,103, 7–14.
Fitts, W. T., & Ravdin, I. S. (1953). What Philadelphia physicians tell patients with cancer. Journal of the American Medical Association,153(10), 901–904.
Fitzgerald, C. J., & Danner, K. M. (2014). Malingering. In T. R. Levine (Ed.), Encyclopedia of deception (pp. 641–642). Thousand Oaks: Sage.
Fox, R. C., & Swazey, J. P. (2008). Observing bioethics. New York: Oxford University Press.
Frank, G., Blackhall, L. J., Michel, V., Murphy, S. T., Azen, S. P., & Park, K. (1998). A discourse of relationships in bioethics: Patient autonomy and end-of-life decision making among elderly Korean Americans. Medical Anthropology Quarterly,12(4), 403–423.
Garcia-Preto, N. (2016). Latino families: An overview. In M. McGoldrick, J. Giordano, & N. Garcia-Preto (Eds.), Ethnicity and family therapy (3rd ed., pp. 153–165). New York: The Guilford Press.
Gordon, E. J., & Daugherty, C. K. (2003). ‘Hitting you over the head’: Oncologists’ disclosure of prognosis to advanced cancer patients. Bioethics,17(2), 142–168.
Hartmann, N. (1932). Ethics Vol-I. London: George Allen and Unwin Ltd.
Henderson, L. J. (1935). Physician and patient as a social system. New England Journal of Medicine,212, 819–823.
Hooker, W. (1849). Physician and patient, a practical view of medical ethics. New York: Arno Press.
Hubbell, A. P. (2014). Medical and pharmaceutical industry. In T. R. Levine (Ed.), Encyclopedia of deception (pp. 651–653). Thousand Oaks: Sage.
Johnston, C., & Holt, G. (2006). The legal and ethical implications of therapeutic privilege-is it ever justified to withhold treatment information from a competent patient? Clinical Ethics,1(3), 146–151.
Jones, J. H. (1992). The Tuskegee legacy AIDS and the Black community. The Hastings Center Report,22(6), 38–40.
Jonsen, A. R. (2007). The god squad and the origins of transplantation ethics and policy. The Journal of Law, Medicine, and Ethics,35, 238–240.
Kant, I. (1936). Lectures on ethics (L. Infeld, Trans.). New York: Harper & Row.
Katz, J. (2002). The silent world of doctor and patient. Baltimore: Johns Hopkins University Press.
Kaufman, W. (1953, January). Should doctors tell the truth? Coronet, 33, 22–26.
Krisman-Scott, M. A. (2000). An historical analysis of disclosure of terminal status. Journal of Nursing Scholarship,32(1), 47–52.
Kübler-Ross, E. (1969). On death and dying. New York: Scribner’s.
Kübler-Ross, E., Wessler, S., & Avioli, L. V. (1972). On death and dying. Journal of the American Medical Association,221(2), 174–179.
Lamont, E. B., & Christakis, N. A. (1999). Some elements of prognosis in terminal cancer. Oncology-Huntington,13(8), 1165–1170.
Larkin, C., & Searight, H. R. (2014). A systematic review of cultural preferences for receiving medical “bad news” in the United States. Health,6(16), 2162–2173.
MacKenzie, C. R. (2009). What would a good doctor do? Reflections on the ethics of medicine. HSS Journal: The Musculoskeletal Journal of Hospital for Special Surgery,5(2), 196–199.
Maloney, F. G. (1954). Should a patient be told he has cancer? Wisconsin Medical Journal,53, 541–544.
Markel, H. (2004). “I swear by Apollo”—On taking the Hippocratic Oath. New England Journal of Medicine,350, 2026–2029.
Martin, S. (2015). A short history of disease: Plagues, poxes, and civilizations. Harpenden Herts, UK: Oldcastle Books.
McKinney, Jr., R. E., Beskow, L. M., Ford, D. E., Lantos, J. D., McCall, J., Patrick-Lake, B., …, & Weinfurt, K. (2015). Use of altered informed consent in pragmatic clinical research. Clinical Trials, 12, 494–502.
Meisel, A. (1979). The exceptions to the informed consent doctrine: Striking a balance between competing values in medical decision-making. Wisconsin Law Review,2, 413–488.
Meisel, A., & Kuczewski, M. (1996). Legal and ethical myths about informed consent. Archives of Internal Medicine,156, 2521–2526.
Mullan, R. (2016). Mad to be normal. New York: Routledge.
Natanson v. Kline, 350 P 2d 1093, 1104 (Kansas, 1960).
Nie, J. B. (2013). Medical ethics in China: A transcultural interpretation. London: Routledge.
Novack, D. H., Plumer, R., Smith, R. L., Ochitill, H., Morrow, G. R., & Bennett, J. M. (1979). Changes in physicians’ attitudes toward telling the cancer patient. Journal of the American Medical Association,241, 897–900.
Oken, D. (1961). What to tell cancer patients: A study of medical attitudes. Journal of the American Medical Association,175, 1120–1128.
Owens, D. C. (2018). Medical bondage: Race, gender and the origins of American gynecology. Athens, GA: University of Georgia Press.
Page, K. (2012). The four principles: Can they be measured and do they predict ethical decision-making? BMC Medical Ethics, 13, 1–8.
Pellegrino, E. D., & Thomasma, D. C. (1987). The conflict between autonomy and beneficence in medical ethics: Proposal for a resolution. Journal of Contemporary Health Law and Policy,3, 23–46.
Pellegrino, E. D., & Thomasma, D. C. (1993). The virtues in medical practice. New York: Oxford University Press.
Pence, G. (2014). Medical ethics: Accounts of groundbreaking cases (7th ed.). New York: McGraw Hill.
Pence, G. (2017). Medical ethics: Accounts of groundbreaking cases (8th ed.). New York: McGraw Hill.
Percival, T. (2014). Medical ethics. London: Cambridge University Press.
Plante, M. L. (1967). An analysis of informed consent. Fordham Law Review,36, 639–672.
Politi, M. C., Lewis, C. L., & Frosch, D. L. (2012). Supporting shared decisions when clinical evidence is low. Medical Care Research and Review,70, 113S–128S.
Quill, T. E., & Townsend, P. (1991). Bad news: Delivery, dialogue, and dilemmas. Archives of Internal Medicine,151(3), 463–468.
Reibel v. Hughes. (1980). 2 S.C.R. 880.
Reverby, S. M. (2009). Examining Tuskegee: The infamous syphilis study and its legacy. Chapel Hill: University of North Carolina Press.
Rising, M. L. (2017). Truth telling as an element of culturally competent care at end of life. Journal of Transcultural Nursing,28(1), 48–55.
Rosenbaum, M. E., Ferguson, K. J., & Lobas, J. G. (2004). Teaching medical students and residents skills for delivering bad news: A review of strategies. Academic Medicine,79(2), 107–117.
Rothman, K. (1991). Strangers at the bedside. New York: Basic Books.
Salgo v. Leland Stanford Jr. Board of Trustees, 317 P.2d 170 (Cal. Ct. App 1957).
Schloendorff v. Society of New York Hospital, 105 NE 92 (NY 1914).
Searight, H. R. (1992). Assessing patient competence for medical decision making. American Family Physician,45(2), 751–759.
Searight, H. R. (2016). Guantanamo, anorexia nervosa, and death row: What are the limits of autonomy? Psyccritiques, 61(21).
Searight, H. R., & Barbarash, R. A. (1994). Informed consent: Clinical and legal issues in family practice. Family Medicine,26(4), 244–249.
Searight, H. R., & Gafford, J. (2005a). Cultural diversity at the end of life: Issues and guidelines for family physicians. American Family Physician,71(3), 515–522.
Searight, H. R., & Gafford, J. (2005b). “It’s like playing with your destiny”: Bosnian immigrants’ views of advance directives and end-of-life decision-making. Journal of Immigrant Health,7(3), 195–203.
Searight, H. R., & Miller, C. K. (1996). Remembering and interpreting informed consent: A qualitative study of drug trial participants. The Journal of the American Board of Family Practice,9(1), 14–22.
Sisk, B., Frankel, R., Kodish, E., & Isaacson, J. H. (2016). The truth about truth-telling in American medicine: A brief history. The Permanente Journal,20(3), 74–77.
Smith, D. H. (1988). Communication as a reflection of and a source for values in health. Journal of Applied Communication Research,16(1), 29–38.
Smith, R. C. (2002). Patient-centered interviewing: An evidence-based method. Philadelphia: Lippincott, Williams & Wilkins.
Smith, T. J., Dow, L. A., Khatcheressian, J., & Lyckholm, L. J. (2010). Giving honest information to patients with advanced cancer maintains hope. Oncology,24(6), 521–528.
Stearns, S. A. (2014). Context. In T. R. Levine (Ed.), Encyclopedia of deception (pp. 215–216). Thousand Oaks: Sage.
Stewart, M. A. (1995). Effective physician-patient communication and health outcomes: A review. CMAJ: Canadian Medical Association Journal,152(9), 1423–1433.
Theobald, P., & Wood, K. L. (2009). Communitarianism and multiculturalism in the academy. Journal of Thought,44, 9–23.
Tomes, N. (2016). Remaking the American patient: How Madison Avenue turned patients into consumers. Chapel Hill: The University of North Carolina Press.
Truog, R. D., Brown, S. D., Browning, D., Hundert, E. M., Rider, E. A., Bell, S. K., & Meyer, E. C. (2015). Microethics: The ethics of everyday clinical practice. Hastings Center Report, 45, 11–17.
Walter, P. (1997). The doctrine of informed consent: To inform or not to inform. St. John’s Law Review,71, 543–590.
Washington, H. A. (2006). Medical apartheid: The dark history of medical experimentation on Black Americans from colonial times to the present. New York: Doubleday Books.
Weir, R. (1980). Truthtelling in medicine. Perspectives in Biology and Medicine,24, 95–112.
Yang, J., Scarfe, W. C., & Angelopoulos, C. (2018). Incidental findings on CBCT. In W. C. Scarfe & C. Angelopoulos (Eds.), Maxillofacial cone beam computed tomography (pp. 553–589). New York: Springer.
Yost, E. (1936, January). A patient wants to know. Scribner’s Magazine, 99, 47–49.
Zhao, W. (2015). A Confucian worldview and family-based informed consent. A case of concealing illness from the patient in China. In F. Ruiping (Ed.), Family-oriented informed consent: East Asian & American perspectives (pp. 231–244). Dordrecht: Springer.
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Russell Searight, H., Meredith, T. (2019). Physician Deception and Telling the Truth About Medical “Bad News”: History, Ethical Perspectives, and Cultural Issues. In: Docan-Morgan, T. (eds) The Palgrave Handbook of Deceptive Communication. Palgrave Macmillan, Cham. https://doi.org/10.1007/978-3-319-96334-1_34
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