A Layman Looks at Truth Telling in Medicine

TRUTH telling to patients is often debated as though the only issue is whether physicians are obligated to tell what they know. Far more consequential are these issues: Does the physician always know the truth? Are there instances in which what was believed to be true—even by renowned authorities—turned out to be a fraction of the truth or no truth at all? Are such cases so infrequent to be of no consequence? Is there an art to truth telling, as there is to everything else? What is the effect of truth on the patient? To what extent can total candor undermine the physician's effectiveness in dealing with the ravages of disease? How does unvarnished disclosure affect the quality of life—and therefore quality of dying? Is the fear of malpractice suits causing some physicians to be explicit to the point of overkill? These questions are not merely rhetorical exercises. They affect