11. CASE: Truth-Telling

The patient is an 89-year-old gentleman with moderate dementia and a history of COPD, swallowing difficulties, a CVA, and recent aspiration. The investigation of his aspiration uncovered a lesion in his lung- the physicians felt it was likely to be cancerous. Thoracic surgery verified that it was lung cancer and a determination was made that he would not be a candidate for surgery or chemo, but potentially for radiation if he were to become symptomatic.

Sometime later, the patient underwent a CT scan, which showed that the lesion had not grown much. The attending physician believes the patient is more likely to die from aspiration pneumonia than his cancer.

The patient’s son does not want him to be told about the cancer for fear he might become depressed and “give up.” According to the physician, the patient can engage in discussions about his health, i.e. diet, etc., but would need assistance from his son for any major decisions.

The health care team is questioning whether they are doing the right thing by following the son’s wishes and not telling the patient about his cancer diagnosis. They put in a call to the ethics line.

  • Identify the competing values in this case
  • How will you proceed with this request?
  • Who should make the decision about what information the patient receives?
  • How does one really know what is best for a patient?
  • Is withholding health care information from a patient ever the right decision?

Some Values and Ethics Issues to Consider

  • Honesty, trust and truth-telling
  • Respect for patient autonomy
  • Patient-family relationships
  • Capacity
  • Moral distress among health care providers
  • Respect for professional integrity
  • Substitute decision-making
  • Beneficence and non-maleficence

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