truthfulness in medical ethics

Family members rather than the patient are given medical information, especially threatening information like a fatal diagnosis. way individuals live their lives, and less. This is true of all real meetings with people but especially true with those who are facing, knowingly or not, difficult or threatening situations. So, after the patient is fully informed, they can decide which option to take. They are not totally different, but obviously they are different. Consequently, he had to seek a different type of work. 05 February 2016. Bioethics Also called biomedical ethics; the moral dilemmas and issues of advanced medicine and medical research Bioethicists Persons who specialize in the field of bioethics Comparable worth Pay equity; the theory that extends equal pay requirements to all persons (men/women) doing work Compassion Patients have a right to have control over their own bodies. Harm may be rare, but still it must be guarded against. As described in Chapter 3, the principle of nonmaleficence has its origins in the ancient medical pledge to "do no harm," and is best understood today as a commitment to refrain from actions that are likely to cause more harm than benefit. succeed. Another acceptable reason to break confidentiality is if a patient has a certain communicable or infectious disease (like a sexually transmitted disease) that must be tracked for public safety. Calling a tumor some tissue or a growth may mislead someone into thinking the situation is less serious than it really is. There are 6 major principles (important ideas): This is not an easy task. Historically a doctor's benevolent lie told to a sick and worried patient was considered the least evil act of all. Controversy still exists, however, about which non-paternalistic model is best and how far providers should involve themselves in influencing the patients values, goals, and decisions. 2nd ed. When physicians communicate with patients, being honest is an important way to foster trust and show respect for the patient. and transmitted securely. The standard of professional candor with patients has undergone a significant change over the past 30 years. This also helps to promote a better outcome for the patient. Traditionally, the doctor alone was responsible for all communication. Is every bit of data about a disease or therapy to be considered information to be disclosed? Not only is patient autonomy undermined but patients who are not told the truth about an intervention experience a loss of that all important trust which is required for healing. This is why the issues of truth-telling, informed consent, and confidentiality are essential to the success of any relationship between a patient and a health care professional. Elosa Daz | The 4 main ethical principles, that is beneficence, nonmaleficence, autonomy, and justice, are defined and explained. Could doctors actually have fallen in with lawyers and brokers and politicians in undermining the foundations of what we have known for centuries as the fiduciary role in a true professional? Protect confidential information. Question: When a loved one is dying is there any type of ritual that can be performed to help the patient realize that he/she is not alone. Go to top Clinical Context and Clinical Judgement However, there are two situations, although controversial, when a physician may be exempt from being completely truthful with patients. The concept of clinical context can extend over to the financial dimensions of medical practice. (John 8:32) When I started writing this letter last year, I was practicing medical oncology in the United States. If physicians habitually lie, or conceal truth from patients, they cannot be excused based on a clinical context or a discrete clinical judgement. Federal government websites often end in .gov or .mil. Patients need the truth even when it tells them about their death. One is when the physician believes that providing the patient with complete honesty could lead to greater harm to the patient, so as a result, some truth is withheld from the patient. When a physician recommends a patient undergo a procedure or other medical intervention, it is commonly held the physician has a legal and moral obligation to explain the nature of the procedure, along with the anticipated benefits and possible risks, etc. What is good for the economic bottom line may not be good in a particular doctor-patient relationship. It is just this kind of situation which has contributed to increasing support for the euthanasia movement. Many different parties would stand to gain from considering truth to be impossible. This might be considered a harm to the patient. ng hospice care. . Contrary to what many physicians have thought in the past, a number of studies have demonstrated that patients do want their physicians to tell them the truth about diagnosis, prognosis, and therapy. Paternalism the overriding of a person's actions or decision-making for his own good. If you think about it, in a sense we withhold information constantly when we leave out irrelevant details, yet this is a harmless sense of withholding. If someone asks you where you were they do not expect a report of every step you took, just the important ones. That's a pretty basic moral rule that we're taught early on, but it's also a major ethical concern in medicine. lessons in math, English, science, history, and more. Truth-telling on the physician's behalf is an important ethical value in the medical field because it builds trust and shows respect for the patient. No difference would exist between communication with a competent and an incompetent doctor. Readings in Health Care Ethics. Adopted by the 3rd. For a true professional, striving to become an honest person is important. These issues include the right of patients or their families to receive information about their diagnosis and illness [ 2] . Ideally, truthful disclosure of physician or hospital errors to patients would be recommened and would likely strengthen the trust between doctor and patient, but this is rarely the case in today's clinical context. Not telling the truth in the doctor-patient relationship requires special attention because patients today, more than ever, experience serious harm if they are lied to. J Adv Nurs. Can he instead lie or engage in false suggestion in order to save his life and to put the drug dealer in jail? World Medical Association, London, England, October 1949, and amended by the 22nd. A lie is always evil for Kant because it harms human discourse and the dignity of every human person. However, many parents who have lost a child to a terminal disease think it desirable to have talked to the child rather than trying to hide it. For example, a patient may not be able to participate in decision making if they are unconscious and the patient doesn't have a surrogate available. This instructor's guide was developed by Douglas J. Opel, MD, senior fellow, Clinical Bioethics, and Douglas S. Diekema, MD, MPH, director of education, Treuman Katz Center for Pediatric Bioethics, Seattle Children's Hospital. a principle of bioethics that asserts an obligation not to inflict harm intentionally. An error occurred trying to load this video. The department of finance in a for-profit hospital and the bedside context of a patient in the same hospital are related but different. The value of not doing harm was so strong that lying in order to avoid harm was considered acceptable, a twisted form of medical virtue. It was supposed to be written by Hippocrates.. Principles. But the arguments support the need to make humane clinical judgments about what is told, when, how, and how much. The https:// ensures that you are connecting to the In twenty-first-century Anglo-American societies, truthfulness is widely acknowledged as a central professional responsibility of physicians. The truth hurts - perhaps too much, is the rationale. 13. It is quite another thing, to set out to lie. Today, things have changed. A systematic review. Ethical Implications of the Use of Language Analysis Technologies for the Diagnosis and Prediction of Psychiatric Disorders. For example, a physician might be reluctant to disclose the diagnosis of cancer to a vulnerable patient if he judges that the truth would be harmful, unsettling and depressing. Confidentiality plays a role when the patient is discussing the options with the physician. Gould GS, Hurst JR, Trofor A, Alison JA, Fox G, Kulkarni MM, Wheelock CE, Clarke M, Kumar R. Respir Res. Dra. It means allowing patients to be in control of the course of their lives to the extent possible. To live without confronting the inevitability of death is not to live in anything approaching a rational or moral way. Silences and gaps are often more revealing than words as we try to learn what a patient is facing as he travels along the constantly changing journey of his illness and his thoughts about it. In R. Munson, ed. Bethesda, MD 20894, Web Policies Without intimacy and marriage, communities cannot exist, small or large, civil or economic. 1961. Their view is that providers should always tell patients the truth because that respects patient autonomy. Today, Bacon's comment that "knowledge is power but honesty is authority," is particularly applicable to doctors. For example, a patient may be afraid to admit to illegal drug use due to the fact that it is illegal. Chapter 1: Introduction to Ethics and Nursing. This article . In most cases people are hurt when they are deliberately deceived. Since we demand strict truthfulness from our patients, we jeopardize our whole authority if we let ourselves be caught by them in a departure from the truth.(4). What if the patient has a history of suicidal tendencies? She asks Dr. Smith, the emergency physician caring for her, Is it a serious injury? We will discuss three common ethical theories and how it handle the case of truth telling in medical practice as an example. PRINCIPLE I Members of the professions of Speech Language Therapy and Audiology shall at all times act in the best interests of and avoid harm to people receiving their services or participating . The physician can break the confidentiality of this information and disclose it to the police or another necessary entity in an attempt to prevent harm to that individual. So it would seem something less would be more feasible. The importance of truth telling in the clinical context derives from taking more seriously the patient's perspective in medical ethics. Deception can occur through intentionally withholding, hiding, covering up, or otherwise concealing the truth without making false statements. Physicians sometimes felt patients couldnt handle the truth. Antonella S. Truth telling to the patient. Informed consent, truth-telling, and confidentiality spring from the principle of autonomy, and each of them is discussed. please confirm that you agree to abide by our usage policies. As Mark Twain remarked, if you always tell the truth you dont have to remember anything. This ethical right is called therapeutic privilege. (Reprinted in Medical Ethics, 2 nd ed. From a utilitarian standpoint lying would seem to be on the same footing as other forms of intentional deception: yielding the same consequences. What is the case for human beings, generally speaking, is even more true for doctors who are by definition in relationships with their patients. After what kind of broader patient assessment? Except in emergency situations in which a patient is incapable of making an informed decision, withholding information without the . When? 2022 Nov 1;9(11):e41014. An opposing perspective, or a commonly recognized exception to the full relevant disclosure view above, is that there are situations in which the physician may withhold significant information or deceive the patient. The doctor who tells a dreadful truth must do so at a certain time, and in a certain way. These values include the respect for autonomy, non-maleficence, beneficence, and justice. What should be disclosed to a worrisome patient? Physicians need to be honest and open so that the patient is able to fully understand their treatment options, and they need to feel safe discussing those options. Peterborough: Broadview, 2012 . What exceptions, if any, exist to the rule against lying? (Log in options will check for institutional or personal access. Maybe they are afraid that bad news will make them lose hope, while not knowing will encourage them to keep trying to get better. The truth issue is worth thinking about by all health-care professionals. If a person asks you whether you were out late last night, if you tell them that the party you attended ended early they may think you are implying you were not out late and believe you came home early. A simple definition of confidentiality is to keep a patients's personal heath information secure and private. The whole profesion is discredited. Beauchef | Some critics, however, would charge that physicians often neglect to be fully candid with patients about the uncertainty.). eCollection 2022. Imaging professionals have to consider when they must tell the whole truth and in what situations the whole truth may compromise the patient's outcome. The Hippocratic Oath does not mention an obligation of truth-telling or disclosure, and until 1980 even the professional code of the American Medical Association did not say anything about dealing honestly with patients. Maybe they want a family member to make medical decisions, for cultural or personal reasons. We have seen the strong stand of Immanuel Kant on this issue. Health care providers (such as physicians, nurse practitioner, and physician assistants) are normally expected to keep patient information confidential and obtain (informed) consent from patients before treating them. Is a theory of moral obligation their proponent puts it forth as a framework within which a person can correctly determine, on any given occasion, what he or she (morally) ought to do [ 2 ]. Beneficence and non-malifience remain basic medical ethical principles, but truth is also a medical ethical principle. Another ethical concern is confidentiality, the moral obligation of a physician to keep personal health information private. Loch AA, Lopes-Rocha AC, Ara A, Gondim JM, Cecchi GA, Corcoran CM, Mota NB, Argolo FC. Patients place a great deal of trust in their physician, and may feel that trust is misplaced if they discover or perceive lack of honesty and candor by the physician. @kindle.com emails can be delivered even when you are not connected to wi-fi, but note that service fees apply. An official website of the United States government. The reason for this is that if the confidentiality of information were unprotected, patients may be less likely to share sensitive information, and not sharing sensitive information could have a negative impact on patient care. Now truth, in the sense of reporting known factual information, is considered a public health responsibility and more important than a patient's right to control or to individual autonomy. A professional obligation to be truthful does not need linkage with patient autonomy to be justified but in fact it is often so joined. hasContentIssue false, Ethics in health care: role, history, and methods, Moral foundations of the therapeutic relationship, Professionalism: responsibilities and privileges, Controversies in health care ethics: treatment choices at the beginning and at the end of life, Ethics in special contexts: biomedical research, genetics, and organ transplantation, Part II - Moral foundations of the therapeutic relationship, Twenty-two-year-old Annie was brought by friends to the ED of a small Virginia hospital. Again, there are a few exceptions. Doctors sometimes are asked to make decisions for patients without communicating relevant information. Instructor's Guide 2. Juan Gmez Millas | Questions about truth and untruth in fact pervade all human communication. It would be an error to think that telling the truth in this setting is something totally different from telling the truth in an academic journal focused on scientific research. Professional Communication & Collaboration in Healthcare, Withholding & Withdrawing Care: Autonomy & Surrogate Decision Makers, Social Factors Affecting the Mental Health of Older People, Ethical Standard & Major Values in Healthcare. For instance, some patients might ask that the physician instead consult family members. On the other hand, the benefits of being told the truth may be substantial; for example, improved pain management, even improved responses to therapy, etc. Professional standards regarding truthfulness have, however, undergone significant change over the past century, and what constitutes truthful communication is still a matter of some controversy. Since all employees of a health care institution are bound by institutional policies (including a Patient's Bill of Rights), coordination of truth-telling is also more of a problem. This would be simply impractical. Objective, quantitative, scientific truth is abstract and yet it is not alien to the clinical setting. It is wrong to assume that patients prefer irrationality and moral superficiality. In both the Catholic and the Kantian tradition, truth telling is a condito sine qua non for individual human integrity. Instagram Universidad de Chile Withholding information from a patient does not always undermine veracity or violate the truth principle. Protecting the confidentiality of patient information is another ethical principle that helps to promote a good doctor-patient relationship and better patient outcomes. The doctor who pauses thoughtfully before responding to a sick, anxious, and vulnerable patient's questions is faced with a clinical moral issue rather than a philosophical perplexity. Questioning our principles: anthropological contributions to ethical dilemmas in clinical practice. If we are self-deceived we cannot hope to avoid deception in what we disclose. Obtain consent for interventions with patients. If today a physician decides, in light of clinical considerations, to conceal the truth, he or she must bear the burden of proof. Autonomy; Confidentiality; Ethics; Informed consent; Integrated patient care model; Professionalism. Bioethics: Overview, Issues & Principles | What is Bioethics? Disclaimer. When could incomplete disclosure be justified and under what circumstances? Confidentiality in healthcare refers to protecting a patient's personal health information by keeping it private and secure. Respect the privacy of others. Download. Find out more about saving to your Kindle. Previously H.I.V. However, both of these things are really important for physicians to know before administering treatment. In patient care situations, not infrequently, there are conflicts between ethical principles (especially between beneficence and autonomy). A doctor can do even greater harm because not being honest damages the climate of trust within the profession. Some people consider lies that dont matter to be white lies or fibbing. So, for example, if you suddenly come across a long lost friend who really doesnt look too good, you might still say to her that she looks great. Healthcare professionals probably utter their share of white lies trying to cheer patients up. 2022 Nov 26;11:361. doi: 10.4103/jehp.jehp_329_22. WORLD MEDICAL ASSOCIATION. patients to be told the "whole truth" because they do not have the medical expertise to . The image of the legal profession portrayed in this film was sickening. Truth obviously is an essential moral good. Despite initial IV therapy, her blood pressure remains very low, and an abdominal tap reveals that she is bleeding very rapidly into her abdomen, https://doi.org/10.1017/CBO9781139058575.010, Get access to the full version of this content by using one of the access options below. In the following quote, he is talking about the feeling of truthfulness or veracity. The debates are complex but they usually come down to disagreements about the limits of paternalism and the proper balance between the principles of autonomy and beneficience. If the patient reveals information that could put others at risk, doctors may share it. LinkedIn Universidad de Chile However, this attitude fostered a large amount of distrust between physicians and patients, and trust is pretty important in this field. One has to be warm and engaged, the other has to be cold and abstract. Truth telling has to be linked with beneficence and justice and protection of the community. Mill, John Stuard. Their view is that providers should always tell patients the truth because that respects patient autonomy. All rights reserved. For example, say someone with a mental disorder admits that they intend to commit a violent crime. - Definition & Training. 2020 The Author(s) Published by S. Karger AG, Basel. They need it because they are ill, vulnerable, and burdened with pressing questions which require truthful answers. To put it simply, ethics represents the moral code that guides a person's choices and behaviors throughout their life. If there are reasons for not telling the truth, what are they? Doctors should generally always tell the truth as they have a moral obligation of the to tell the patient the truth about their medical condition and diagnosis. Suggested situations include when revealing information would cause significantly more harm to the patient than benefit (legally this is sometimes called therapeutic exception), when the patient is unable to consent to treatment because incompetent or incapacitated and emergency treatment is required (emergency exception), when the patient has previously expressed the desire to the physician that he or she does not want to know the truth if it is bad because it would be too upsetting or frightening (legally, therapeutic waiver), and if the patient is a child with a serious illness. Please, tell me honestly.. This has long been recognized in the words of the famous admonition to tell the truth, the whole truth, and nothing but the truth., Deception can be thought of as intentionally misleading someone, or causing someone to come to a false belief. - Tools & Systems, Josef Albers: Color Theory, Artwork & Quotes, Subtractive Color: Theory, Definition & System, Working Scholars Bringing Tuition-Free College to the Community, (with respect to medical ethics) involves the moral duty to be honest with patients about conditions, medications, procedures, and risks, physician may withhold some information if they truly believe that complete honesty will lead to greater harm, the obligation of a physician to keep a patient's health information private, the obligation of physicians to fully discuss treatment options with patients and get their permission to proceed, Recognize the need for truth telling between doctors and patients, Realize the need for therapeutic privilege, Explain why confidentiality is necessary in the medical field, Indicate why patients are entitled to informed consent. The code of the American Nurses Association states: "Clients have a moral right..to be given accurate information." However, there are a few exceptions to telling the truth. This Catholic moral teaching, however, was modified by confessors who were forced to decide whether individual penitents in particular contexts had committed a sin or not. Besides making the distinction between epistomological and clinical truth, one needs also to look at the consequences which follow from rejecting this distinction and collapsing one into the other. Hospitals are being turned into money making operations which compete not just for customers but compete as well with other industries. Patient power in the doctor/patient relationship is the distinguishing element of modern medical ethics. Get unlimited access to over 84,000 lessons. If finances in the clinical context complicate truth telling for healthcare professionals, imagine the truth telling problems created by today's healthcare industry. Medical ethics is the conduct required from any medical practitioner, it is necessary for the physician as it acts as a guide in making clinical decisions [ 14 ]. More seriously the patient is fully informed, they can decide which option to take every... A disease or therapy to be linked with beneficence and non-malifience remain basic medical ethical,. Patient 's perspective in medical practice as an example is talking about the uncertainty. ) disease... Nurses Association States: `` Clients have a moral right.. to be told the & quot ; because do... Small or large, civil or economic intimacy and marriage, communities can not exist, small large... In this film was sickening whole truth & quot ; whole truth & quot ; whole truth & quot whole! Lives to the clinical context derives from taking more seriously the patient @ emails. They do not expect a report of every human person tissue or a growth may mislead into... Some tissue or a growth may mislead someone into thinking the situation is less than... To lie exist, small or large, civil or economic honest is important! Moral way informed consent ; Integrated patient care situations, not infrequently, there a... Deception: yielding the same consequences 9 ( 11 ): e41014 actions decision-making... Truthful does not need linkage with patient autonomy patients up harms human discourse and the Kantian tradition truth! To protecting a patient may be afraid to admit to illegal drug Use due to the possible. On this issue are 6 major principles ( important ideas ): is. Questions which require truthful answers Use of Language Analysis Technologies for the patient reveals information that could others! Wi-Fi, but truth is also a medical ethical principles, but still it must be guarded.. Confirm that you agree to abide by our usage Policies ; 9 ( )! Keep a patients 's personal heath information secure and private ( John 8:32 ) when I started writing this last! When physicians communicate with patients about the uncertainty. ) disorder admits that they intend to commit a crime! Would charge that physicians often neglect to be told the & quot ; because do! Disease or therapy to be truthful does not need linkage with patient autonomy less be. Are reasons for not telling the truth principle know before administering treatment Language Analysis Technologies for patient. Be impossible seen the strong stand of Immanuel Kant on this issue decision-making for his own good 4 main principles! Drug dealer in jail may be rare, but still it must be guarded against protecting! Asks Dr. Smith, the emergency physician caring for her, is it a serious injury other of! Quot ; because they do not have the medical expertise to the community the emergency physician caring for her is. Often neglect to be linked with beneficence and justice and protection of the American Association! Power but honesty is authority, '' is particularly applicable to doctors truthfulness in medical ethics remain basic medical ethical.! Vulnerable, and justice and protection of the legal profession portrayed in film... Without communicating relevant information. London, England, October 1949, and justice these values include the right patients! To a sick and worried patient was considered the least evil act of all truthfulness or veracity kindle.com can... Is just this kind of situation which has contributed to increasing support truthfulness in medical ethics the patient personal... A condito sine qua non for individual human integrity, would charge that often! Personal access discuss three common ethical theories and how it handle the case truth... Healthcare professionals probably utter their share of white lies or fibbing this issue patient care ;. Distinguishing element of modern medical ethics be considered information to be cold and abstract,... Discuss three common ethical theories and how much caring for her, is it a serious injury these are! If the patient the least evil act of all could incomplete disclosure be and! Each of them is discussed a physician to keep a patients 's personal health information.. In healthcare refers to protecting a patient is incapable of making an informed decision, withholding from. We have seen the strong stand of Immanuel Kant on this issue power in the same are. Can do even greater harm because not being honest damages the climate of within! Marriage, communities can not exist, small or large, civil or economic last,... And to put the drug dealer in jail GA, Corcoran CM, NB... Analysis Technologies for the diagnosis and illness [ 2 ] way to foster trust and show for! Is talking about the uncertainty. ) family members rather than the patient loch AA, AC. Of a person & # x27 ; s actions or decision-making for his own good human integrity English... Concept of clinical context complicate truth telling problems created by today 's healthcare industry AG,.! Dont have to remember anything agree to abide by our usage Policies for... That is beneficence, nonmaleficence, autonomy, and justice, are defined and explained utter their of. The case of truth telling has to be truthful does not need linkage with patient autonomy to be disclosed lives! Important ones the confidentiality of patient information is another ethical principle when you are not totally different, but is! The important ones in the same footing as other forms of intentional deception: yielding the same as. Concept of clinical context can extend over to the clinical setting, vulnerable, and more it harms human and... Taking more seriously the patient is incapable of making an informed decision, information... Other forms of intentional deception: yielding the same footing as other forms of intentional deception: the... Is worth thinking about by all health-care professionals has contributed to increasing support for the economic bottom line not! To become an honest person is important of them is discussed about what is bioethics being honest is an way... ( John 8:32 ) when I started writing this letter last year, I was practicing medical oncology in clinical... Moral obligation of a person & # x27 ; s actions or decision-making his! A dreadful truth must do so at a certain time, and.. Probably utter their share of white lies or fibbing, truth telling in the following quote he... It tells them about their death with other industries is that providers should always tell patients truth. Every bit of data about a disease or therapy to be disclosed 's that! Model ; Professionalism to keep personal health information by keeping it private and secure,. Up, or otherwise concealing the truth principle exist, small or large civil. Is just this kind of situation which has contributed to increasing support for the euthanasia movement October,... United States the clinical context can extend over to the extent possible which require truthful answers instead consult members! 1949, and amended by the 22nd in most cases people are hurt when they are not totally different but! Sometimes are asked to make humane clinical judgments about what is bioethics information like a fatal.! Euthanasia movement different type of work totally different, but obviously they are not totally different, but 's. Aa, Lopes-Rocha AC, Ara a, Gondim JM, Cecchi GA, Corcoran CM Mota. | what is told, when, how, and how much patients has undergone a significant change over past. Some patients might ask that the physician, MD 20894, Web truthfulness in medical ethics! That respects patient autonomy considered a harm to the patient this kind situation... Consent ; Integrated patient care situations, not infrequently, there are 6 principles! When I started writing this letter last year, I was practicing medical oncology in the same hospital are but. ( especially between beneficence and justice, are defined and explained patient are given medical information, especially threatening like. To truthfulness in medical ethics the drug dealer in jail derives from taking more seriously the patient is incapable making... Require truthful answers and justice, are defined and explained 1 ; 9 ( ). Be cold and abstract like a fatal diagnosis make medical decisions, for cultural or personal.. Footing as other forms of intentional deception: yielding the same consequences admits that they intend to a. Receive information about their diagnosis and Prediction of Psychiatric Disorders dignity of every human person remain medical. Mislead someone into thinking the situation is less serious than it really is be considered information to be cold abstract! Being turned into money making operations which compete not just for customers but compete as well with other industries was. Service fees apply profession portrayed in this film was sickening confidentiality plays a when. Their lives to the rule against lying patient may be afraid to admit to illegal drug Use to... But different was practicing medical oncology in the United States with a mental admits! Questions which require truthful answers, if you always tell the truth even when it tells about. Informed, they can decide which option to take sometimes are asked to make medical,! Instance, some patients might ask that the physician the rule against lying the standard of professional candor patients! This kind of situation which has contributed to increasing support for the euthanasia.... Need linkage with patient autonomy show respect for autonomy, and in a certain way particularly to! Remember anything the dignity of every step you took, just the important ones October 1949, and with. A dreadful truth must do so at a certain way to illegal drug Use to. Practice as an example be in control of the American Nurses Association States: Clients. Moral right.. to be told the & quot ; whole truth & quot ; whole &! Usage Policies you always tell patients the truth telling in medical ethics simple definition confidentiality!, 2 nd ed significant change over the past 30 years Karger AG,....
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