The Benevolent Deception: When Should a Doctor Lie to Patients?

Truthfulness is the foundation of the doctor-patient relationship, both as a method of discourse and as one of the "most widely praised character traits" of a doctor. Gone are the days when doctors withheld certain diagnoses or treatment details from patients. If anything, doctors today are often forced to disclose excess and sometimes unnecessary information due to concerns about liability or to patients who have already canvassed the Internet on their own and have pressing questions. The doctor's challenge is to present what he or she knows to be true about the diagnosis and its treatment options and to do so in a manner that truly informs the patient. But there are limitations and pitfalls to this process, as illustrated in the following paraphrased conversation I recently had with a seventy-five-year-old moderately demented patient and his wife:

Patient: Doctor, I know I can still drive. Just let me take a test.

Doctor A: I'm sorry, Mr. K, but I can't help you with that. As we discussed, your memory impairment makes it unsafe for you to drive.

Patient: Just let me take the test. I can drive just fine.

Doctor A: The memory testing tells us that you would not be a safe driver.

Patient: My memory is not that bad. I know I can drive.

Patient's wife: Honey, I told you that the car is not working now and needs to be fixed. Let's talk about it later.

Patient: Okay.

Marc E. Agronin, The Atlantic, october 24, 2011.

The vanishing mind

Todd Heisler/The New York Times

Disregarding typical nursing-home rules, Beatitudes allowed Ms. Nance, 96 and afflicted with Alzheimer’s, to sleep, be bathed and dine whenever she wanted, even at 2 a.m. She could eat anything, too, no matter how unhealthy, including unlimited chocolate.
[...]
Dementia patients at Beatitudes are allowed practically anything that brings comfort, even an alcoholic “nip at night,” said Tena Alonzo, director of research. “Whatever your vice is, we’re your folks,” she said.

Once, Ms. Alonzo said: “The state tried to cite us for having chocolate on the nursing chart. They were like, ‘It’s not a medication.’ Yes, it is. It’s better than Xanax.”

Giving Alzheimer’s Patients Their Way, Even Chocolate, The New York Times, december 31, 2010 (more pics).