Truth Telling and Communication
When facing serious health struggles, many health care professionals and family members find it difficult to discuss their diagnosis and prognosis with them. After all, it’s hard to reveal bad news to anyone, especially regarding mortality. Some may also fear that bearing bad news can lead the patient to despair or even cause a physical deterioration in their health.
Ematai endorses the contemporary mainstream medical approach which recommends in most situations not withholding from a patient their true condition.
While every case is different and should be handled individually, sensitively disclosing a diagnosis and prognosis is generally favored for the following reasons:
- Pragmatically, it is difficult to conceal from a patient how sick they are. Patients can tell something is wrong with their body and will ask questions when their treatments change. They may also overhear conversations about their condition that will reveal the extent of their illness in an insensitive manner. It’s better for them to hear the truth in a direct and sensitive manner than making assumptions, which may be much worse than the reality.
- Modern healthcare entails making choices in a state of uncertainty. Questions about treatments like chemotherapy or surgery, for example, require input from the patient, who is entitled, when capable, to make informed decisions for themselves.
- Many healthcare experts question whether revealing someone’s true medical condition can lead to a deterioration in their health. More critical, in this respect, is how sensitively the information is conveyed to them. Good bedside manners can preserve hope, positivity, and fortitude. Health care providers should be trained in the art of truth telling in an empathic and compassionate manner.
- Judaism believes that illness, however unfortunate, also offers an opportunity for meaningful conversations, introspection, repentance, and prayer as well as estate and legacy planning. People should be afforded the opportunity to “get their affairs in order,” whether they relate to financial, spiritual, or emotional matters. Truth telling allows people to live in the moment and act meaningfully until their last breath.
That said, there may be times when it would be harmful to reveal bad news to a sick patient.
- Bad timing: A critically ill patient on their way into surgery may despair if informed about the death of a loved one, for example.
- Inability to understand: Patients with some forms of dementia may not fully comprehend their diagnosis, leading to great anguish and confusion.
- Oversharing: Healthcare professionals may also disclose too much information that causes confusion and leads to excessive anxiety while destroying any sense of hope.
- Respecting the right not to know everything: Patients digest bad news, particularly when it’s a terminal prognosis, in different ways. In some individual cases, a certain amount of unawareness may be helpful on an emotional level. The patient has the right to make that decision. It is inappropriately paternalistic to assert that patients must know everything. The goal of healthcare professionals now is to alleviate suffering, not to douse the denial of death.
Ultimately, a case-by-case approach is preferred. Patients beginning an extended treatment process should be asked at the outset how much he or she wants to be informed and who else they would prefer to be involved in the process. The Ematai conversation guide provides space for individuals to record their general preference for candor about their diagnosis and prognosis. Their answers should be reviewed as the treatment process progresses and outlooks possibly change.
For further reading, see the linked PDFs in the right margin.
- Judah Goldberg, “Towards a Jewish Bioethic: The Case of Truth-Telling,” Tradition 43:2 (2010)
- Alan Jotkowitz, Shimon Glick, M.D., and B. Gezundheit, “Truth-Telling in a Culturally Diverse World,” Cancer Investigation 24, p. 786–789, 2006.
- Shlomo Brody, “Should we tell the truth to the terminally ill?”, The Jerusalem Post, Dec 9, 2021.