Problems in communication : truth-telling and informed consent
This thesis entitled 'Problems in Communication: Truth-telling and Informed Consent' attempts to explore some difficulties generated by any breakdown in communication, no matter how trivial, within health-care. The main concern is with the ethical implications of these breakdowns, as well as their practical application and I concentrate on the intentional breakdowns which are essentially intentional deceptions. As the discussion unfolds it should become clear why truth-telling and informed consent are such major components of successful communication within health-care. It should also become more obvious that within health-care, truth-telling is not regarded as an absolute principle and this is reflected in the high incidence of deception we see occurring within it. Throughout the thesis I quote examples and use case studies to facilitate consideration of the concepts in real terms, the use of which I hope shall render the discussion more interesting and accessible to all who read it. Frequent referrals are made to the ethical principles of utilitarianism* and deontology** and hopefully account will be taken of both view-points. Since I hope to have established that deceptions are commonplace within health-care, I discuss the justifications given for these deceptions and incorporate the principle of paternalism (father knows best attitude). The different ways of withholding information are examined and the moral difference (if any) between withholding information and telling lies is discussed. In general I explore any communications where truth seems to be a principle in conflict with other conflicts. This is not confined to the interactions between practitioners and patients but incorporates the communication problems between differing members of the health-care team. Since I do not advocate an absolutist peon in relation to truth-telling, I approach each individual situation in as open-minded way as possible and hopefully present a fair appraisal of the facts. As well as deliberating on the general ethical problems for health-care providers and patients in relation to truth-telling, I spend some time dissing the problems associated with informed consent. This leads on to a discussion placebic* intervention which like all other forms of deception within health-care has become quite widespread. I discuss the reasons for the widespread use of placebic interventions and look at the benefits and negative effects of this practice. The final part of the thesis is mainly concerned with whistle blowing (staff speaking out about unacceptable practices) which in recent years has become more common from within the realms of health-care. The need for staff to blow the whistle appears to be related to a communiciation breakdown between management and the workforce and a need for staff to expose the truth. This emotive topic is discussed against the background of the experiences of Graham Pink** and I highight how difficult it is for nurses to speak out because of the victimisation and harassment they will surely experience. I look at the law in relation to whistle blowing and introduce the on-going changes which are designed to improve the situation for whistle blowers. In brief I explore a wide range of true-to-life situations where the absence or need for truth creates ethical dilemmas for the individual practitioner.
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