A Research Of Occasions In Physician’s Practice When Deception Is Warranted

Introduction

Throughout time there are has been numerous debates when it comes to healthcare as it evolves rapidly. For instance, deception in the healthcare field has been a very sensitive subject because of varying opinions, professional mannerism and ensuring proper protocol and procedure. In today's society, as technology evolves and information is constantly being published, everyone wants to be informed. In other words, when patients go to the doctor’s office about a health concern or diagnosis, patients believe they already have all the relative information. Therefore, when patients seek “advice” they are generally looking for alternative options that may be available from the doctor’s office. In 1972 Robert Veach developed the “paternalistic/parental/priestly” doctor-patient model relationship which states “the physician makes all decisions regarding medical care of the patient based on his medical expertise and assessment of the patient’s best interests, without consulting the patient”.

Since healthcare has drastically changed since the 1970’s healthcare professionals believe in shared responsibility between the patient and healthcare professional. Developing the “interpretive model” which the objective of the physician-patient relationship is to enlighten the patient's values. The interpretive model defines “the patient’s values and what patient actually wants, and help the patient to select the available medical interventions” (Raina, 2014). Therefore, deception-based off the physician-patient relationship will be considered inappropriate.

Implementing a standard of honesty, integrity and accountability between healthcare professionals not only helps the patients but protects the provider as well. Gerard (2010) stated, 'for consent to be examined, treatment to be valid, there must be three conditions met: first, the patient must be competent; second, they must have sufficient information to make an informed choice and third, the consent must be given voluntarily”. In order for the patient to make a decision about their health, they must be fully knowledgeable about all possible options before they make a decision for themselves or their family members. However, healthcare professionals struggle with gray area information when revealing the 'whole truth' to a patient. In fear that if the patient knows the whole truth about their current situation it could result in making things worse, ultimately it’s not about how much information they should share it’s a debate on when its appropriate time to share.

Scenario

A physician intentionally submits faulty information to an insurance company in an attempt to help a sick patient obtain necessary healthcare services. For years Medical insurance fraud has been a major issue in the healthcare field for years in the United States. In 2005 the United States government “recovered 1.5 billion in fraud settlements and judgments” (Rabecs, 2006). Even though the physician is trying to help a patient may seem noble, the physician still has a code of ethics to uphold. Submitting faulty information to insurance is dishonest and could lead to serious consequences only for the physician but the patient as well. Which is very inappropriate behavior because the United States has dedicated time and resources to help stop the fraud epidemic by 5 percent since the last annual report (Rudman, 2009). Rudman (2009) stated “one of the most common forms of fraud is a falsification of information. In result, healthcare companies have created stricter regulations and increase the cost of coverage to cover the loss of fraud'. Therefore, healthcare providers may feel a need to help others but in the long, they are causing more damage than good.

A physician does not provide full disclosure of a surgical procedure because he/she suspects the patient is not emotionally stable enough to handle all the details of the surgery, treatment, and recovery. Whether the physician has good intentions this is outright unacceptable when it comes to the integrity and standards a medical caregiver should uphold. Many healthcare professionals 'feel' they 'need' to be deceitful to their patients to save them from underlying truths. However, it is very inappropriate for a caregiver to not be honest about a procedure. Part of the Hippocratic Oath reads: “What I may see or hear in the course of the treatment or even outside of the treatment in regard to the life of men, I will keep to myself, holding such things shameful to be spoken about” while there may be situations where a caregiver may feel they need to be dishonest, this behavior is unjustifiable and there are no exceptions.

Problems will arise between the physician and the patient and “informed consent, full disclosure, and honesty is necessary within the context of medical research and a cooperative therapeutic relationship”. “Informed consent was created to help the patient have all the information necessary to come to a decision about their healthcare” according to Appelbaum (2007). Appelbaum also states “Informed consent is the process by which the treating health care provider discloses appropriate information to a competent patient so that the patient may make a voluntary choice to accept or refuse treatment”.

A physician recognizes the patient has psychosomatic symptoms and prescribes a placebo pill in hopes that the emotional relief of the placebo will help the patient recover (thus saving the patient from possible treatments which would be more invasive and/or extensive). In the journal Bioethics, A. Asai and Y. Kadooka (2013) “some patients may feel grateful if the placebo worked, however, others would become angry or feel betrayed from the clinician deception”. There can be serious consequences if a physician is dishonest with their client especially if they feel they were tricked into the situation. If a patient decides that the physician cannot be trusted their symptoms can worsen or they can develop new ones due to psychological stress (Kadooka, 2013). Even though the above scenario has consequences, we should decide if it's really a deception. This will depend on how the placebo bill was described to the patient. As we are aware placebo pills are basically sugar-based pills and there is nothing wrong with prescribing sugar pills to a patient. However, if they were described as a 'cure' or will ease the patient’s symptoms or make everything go away and improve the patient’s overall health then a problem will arise.

For instance, the physician’s states, “this pill will cure all your problems and make you feel normal again” This statement then becomes morally ambiguous, however, if the physician says “I’m prescribing you something that should help you feel subside”. There are very big differences between both statements giving the second statement a truthful outlook. Once the patient asked a follow-up question(s) about the prescription then the physician should be honest and fully transparent of the situations. “Since the placebo effect is more likely to be achieved if the medication is touted as being amazingly effective against complaints like those of the patient, there is a reason for the physician to lie outright”.

Part II (Most Ethical to Least Ethical)

A physician treating a patient with a terminal illness fails to disclose secondary ailments/diseases which may arise (in an attempt to protect the patient’s emotional stability and will to fight). The attempt to protect the patient's emotional stability and will to fight to solely up to the patient, not the physician. Ludwig and Burke (2013) stated that 'the bond of trust between the patient and the physician is vital to the diagnostic and therapeutic process” which is known as the fiduciary relationship. However, for this relationship to develop and thrive the physician must remain transparent with patient and honest about their diagnosis while the patient must be communicating all relevant medical information. Creating a relationship between confidentiality and trust.

As a physician, it is the duty of the physician to disclose secondary ailments, disease, and side effects because it is the patients' rights to know (Ludwig and Burke (2013). According to Ludwig and Burke (2013) patients should always be fully informed and aware of all necessary information, for instance, “the nature of the decision and or procedure the patient may need, reasonable alternatives to the proposed intervention, relevant risks, benefits, and uncertainties related to each alternative, assessment of patient understanding, and the acceptance'. Even though it may seem like the 'right' thing to withhold information it is unethical thus physicians should be concerned with their patient's safety overall. Ludwig and Burke (2013) argue that “Assuming that such disclosure is done with appropriate sensitivity and tact, there is little empirical evidence to support such a fear”. Physicians like many respected professions always have a sense of integrity they must uphold. What they may think is right at the end of the day the patient is always right.

When prescribing pain medication, some physicians may “undertreat” a patient if they sense their patient may have a propensity for addiction. When treating serious illness not only does it come with serious post care, but serious symptoms or habits may rise that can lead to an addictive lifestyle. However, not treating the illness can lead to serious consequences as well which places the physician in very serious bine. 'Not treating pain adequately not only slows recovery but if left untreated can become chronic, at which point it is no longer simply a symptom of a disease but becomes a medical problem in its own right' (Benady, 2005). 'Not treating pain adequately not only slows recovery but if left untreated can become chronic, at which point it is no longer simply a symptom of a disease but becomes a medical problem in its own right'. Therefore, if the physician does not properly treat the patient is left in chronic pain and which will result in the patient finding an alternative route for coping. The best approach is to always be honest even if the physician feels that their patient may develop unpleasant habits never be misleading.

For explain, in “Maze Case” (Veatch, 2000) “Mrs. Maze was five months pregnant and was diagnosed with an illness. In fear that her husband would leave her, she asked the doctor to not tell her husband, therefore, when the husband asks the doctor could not answer because of 'client confidentiality'. Leading the husband not knowing the full diagnosis he went to a 'traditional healer: and unfortunately, she passed away'. When physicians are not transparent with their clients it can lead to unfortunate events in order to reduce hard physician must always hold a duty of care in order to protect their patients.

Physicians accept pharmaceutical perks if they recommend a specific drug for treatment. There are numerous medications out there with numerous side effects some positive and some negative. Even though we can not always test and know every side effect because every individual is different there are some medications that work for some and not for others. However, the healthcare system is one big business, and everyone must make living even if that means deceiving some people. It's not right however, it is the real reality of our healthcare system. However, physicians directly work with people on a daily, they form relationships that are built on honesty and trust with their patients. In the scenario, we must examine the word 'recommend' if the physician just recommends a drug to the patient it is still the patient right to take the medicine. However, if the physician is forcing the medicine on their patients and prescribing to others who it will not help at all then the physician is crossing all types of boundaries and leading with greedy and personal motivates.

There, is nothing wrong with recommending a certain product to a consumer over another product we are faced with those choices every day. Especially if there is a benefit for us personally, however, as a physician they must always remain transparent and make sure whatever they are recommending it is for the betterment of that individual.

Part III

In 2010, my great aunt daughter passed away from colon cancer. She had suffered from health problems for many years and in 2006 she was diagnosed with stage 4 colon cancer that eventually spread throughout her body in a matter of months. I recall my cousin being involved in all possible Physicians accept pharmaceutical perks if they recommend a specific drug for treatment treatments even the well-known cancer treatment facility in Florida. She tried everything and anything to save her life but in the last few months of her living, she became very depressed. She would close her self off in her room for hours even days. She would not even talk to the physician or be active in treatment plans. I remember my grandmother and auntie taking over her health decisions and care treatment plans. The physicians would stop talking around her or would give her minimum information.

During the beginning stages, I believe the physicians were honest with her, I believe they exaggerated some information such as her getting better or hope for a healthy recovery. Once, cancer spread to her entire body they kept giving her hope which I felt they should have just told her there was nothing they could do more. But overall, I believe they were honest but became emotionally attached to my family. For four long years, my family and healthcare professionals have spent hours talking, praying, laughing and crying together. It was a tough situation for everybody and as time went on everybody grew sensitive of losing my cousin. Everybody did the best they could, and my cousin fought a good fight the best she knew how.

Conclusion

A physician has a duty to protect their patient’s wellbeing, but a Christian physician not only follows man's law but Gods law as well. He and she must always be honest because that’s what the Lord commanded and His Word trumps man’s law daily. Proverbs 12:22 (ESV) states, “Lying lips are an abomination to the LORD, but those who act faithfully are his delight”. God is the truth and His Word is truth before, after an eternity, God does not lie to us therefore, we must not lie to each other. However, this is not an easy task for nobody especially physicians when faced with so many difficult situations. While the ninth commandment reminds us not to “bear false witness” Exodus 20:16 (ESV), we must stand on Gods word because as the statements say, “the truth will set you free”.

Even though deceiving may seem easy to do especially if it means helping someone out the Bible does not present an instance where lying is the right thing to do. Every action has a reaction in Proverbs 6:16-19, Psalm 119:29, Ephesians 4:25, and Colossians 3:19 (ESV) warns us against lying or using “falsehoods”. As a healthcare professional lying to a patient breaks trust and leads to consequences that were avoidable from the beginning.

References

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