Lying Doctors Create a Slippery Slope

Written by: Dr. Kathy Gennuso

In a recent article in the NY Times, “When Doctors Need to Lie,” (available here) the author debated with himself the benefits and risks of paternalism, assuring himself that experience has taught him there is a place for it. Maybe — but it is a very slippery slope. Once physicians begin to assert their opinions and beliefs over those of the patient, the physician has crossed the line. Quality of patient care is affected by the treatments that patients receive, as well as by the behavior of their healthcare professionals. Paternalistic physicians may feel justified in deception and choose not to provide their patients with complete, open, and truthful information regarding treatment procedures, especially for terminal illness. Paternalism can lead physicians to willfully ignore patient decisions or not disclose adverse events.

Paternalism can also invade patient advocacy: advocates walk a fine line between patient representation and paternalism. If advocates do not adequately represent patients’ own views, but instead support decisions they believe are best for patients, then they are not acting as advocates, but paternalists. Advocacy pursued in this way is morally wrong because it’s disguised as representation of patient preferences.

Both hospitals and their physicians have great power. With great power comes great responsibility—the responsibility to use the power of ability, advanced skills, and experience to provide patients with high quality care, but not use power to usurp patients’ rights and make their decisions. In some cases of “benevolent” paternalism, patients don’t give up their rights – they’re being taken.