Physician- Patient Disclosure: Transitioning from Truth to Trust
Karl Wallenkampf, Medical Student, MA in Bioethics Student, Loma Linda University School of Medicine & School of Religion
Due to an adherence to either a consequentialist or categorical ethic, traditional approaches to truthfulness in medicine have not always been clearly patient-centered. In their historical survey of truth-telling in American medicine, Bryan Sisk, Richard Frankel, Eric Kodish, and J. Harry Isaacson identify several norms of medical disclosure—that is, truthfulness toward patients about their diseases [1]. They identify three distinct approaches of physician truthfulness. Early approaches emphasized obscurantism that “protected” the patient from terminal diagnosis (though, arguably, provided hope) and the medical field from oversight—even the Hippocratic oath defends professional secrecy. Later, there was a transitional approach to truth-telling as medical associations had to contend with increased layperson mistrust of the medical establishment, much as a result of the early approach. The final and contemporary rule-based “full-disclosure” approach reigns, though it can overwhelm and isolate patients and their families during crisis. In this essay, I will argue that a character and relationship-based approach to truthfulness, one that shifts the focus from truth-telling to physician trustworthiness and faithfulness to the patient, can address the shortcomings of the prevalent consequentialist versus categorical binary. Drawing on the work of Christian ethicists Glen Stassen and David Gushee [2], I will explore how the Judeo-Christian conceptions of covenantal communities and divine faithfulness might inspire models of patient-centered therapeutic relationships based on commitment and trust. My paper will be divided into three main sections. First, I will provide an overview and further analysis of the historical periods and approaches discussed by Sisk, et al. Second, I will distinguish between character-based approaches to ethics and the consequentialist and categorical models, arguing for the relevance of the former in medical disclosure and physician truthfulness. Third, after discussing Stassen & Gushee’s character-based approach to the issue of truthfulness, I will show how such an approach would positively influence the way physicians think about truthfulness to patients, honesty in medical error, and the development of public health initiatives.
[1] Bryan Sisk, Richard Frankel, Eric Kodish, and J. Harry Isaacson, “The truth about truth-telling in American Medicine: a brief history,” The Permanente Journal 20, 3 (2016, Summer). 15-219. DOI: http://dx.doi.org/10.7812/TPP/15-29 (Accessed 22 August 2019).
[2] David P. Gushee and Glen H. Stassen, Kingdom Ethics: Following Jesus in Contemporary Context, 2nd ed. (Grand Rapids, MI: Wm. B. Eerdmans Publishing Co., 2016).
[1] Bryan Sisk, Richard Frankel, Eric Kodish, and J. Harry Isaacson, “The truth about truth-telling in American Medicine: a brief history,” The Permanente Journal 20, 3 (2016, Summer). 15-219. DOI: http://dx.doi.org/10.7812/TPP/15-29 (Accessed 22 August 2019).
[2] David P. Gushee and Glen H. Stassen, Kingdom Ethics: Following Jesus in Contemporary Context, 2nd ed. (Grand Rapids, MI: Wm. B. Eerdmans Publishing Co., 2016).