MEDICINE TODAY
Should doctors tell?
By JOHN ROWAN WILSON
rrHE controversy over Lord Moran's publica- tion of clinical information about Sir Winston. Churchill has raised in an acute form the very delicate question of medical confidence and secrecy. This is, of course, a fundamental part of clinical practice. Medical ethics pro- hibit the disclosure of such information in man's lifetime without his permission. The code is not so specific about what is permissible after a patient's death. Everyone agrees that it was Lord Moran's duty to record his findings about such an unusual man for the benefit of future historians. The real question at issue is whether he should have published them so soon after Churchill's death, and without the permission of the family. I think the view of most medical men is that he should not, and that a similar discretion should have been exercised over any non-medical information which he received while acting in his capacity as a doctor Of course, Lord Moran was (then, at any rate) a friend of the Churchill family, and it might be hard to distinguish what he heard medically from what he heard socially. This is really a question of good taste, and the Lancet is surely right in its belief that people in Lord Moran's position have a special duty to set a good example in such matters. Is there a likelihood that other doctors, in less special circumstances. may be emboldened to write articles containing clinical titbits about deceased celebrities? This would indeed be an alarming prospect. One can visualise, for example, yet another -series of dis- closures about Mr Somerset Maugham, this time on a pathological level. I think few of us would welcome that.
Conceptions of good taste vary, of course, according to what is customary in a particular society at a given time. The Americans, who have never been so reticent on personal matters as we have, publish as a matter of routine the full medical details of all illnesses affecting the head of state, and I remember my astonishment when I first saw an itemised account of Presi- dent Eisenhower's metabolic processes blazoned in flashing lights on a corner of Times Square. Their reporting of new medical treatments and advances in surgery is also much more detailed than we are accustomed to here. However, we are catching up very quickly. Medicine is about life and death and the public are interested. What is more, it concerns them personally, since their own lives may well depend on it. Surely it is reasonable that they should be told what the doctors are up to?
Yes, of course. But with certain reservations. It is obviously impossible for members of the general public to understand all the technical details of modern medical treatment. It may sometimes be better for them to be told nothing at all than to be given an oversimplified or dramatised story. Medical reticence to the lay press is not mere obscurantism. It has a logical
purpose behind it. Doctors are afraid of the raising of false hopes and unnecessary fears, and of misunderStandings which can lead to very considerable distress to patients. It may be that they are over-cautious in this respect-yI think they sometimes are—but they are doing their best to be responsible, and glibcriticisms that they are 'trying to maintain an aura of mystery' are in general unjustified.
The other form of secrecy which is sometimes criticised is when the patient is kept in ignorance of a fatal prognosis. Once again, it is often argued that the patient has the right to know. But anyone who has really had to face this problem knows that the type of person who can face up to his own imminent and inescapable death is a rare exception. Hope is an essential part of the force which keeps most of us alive and it is a terrible responsibility to destroy it. In the words of one patient to an eminent sur- geon, 'Since I heard that I had no chance, every mouthful I eat seems like a waste of food.' Near relatives should obviously be told every- thing, and the patient should be told, too, if he seriously invites it. But the significant thing is how few patients, when it comes to the point, do ask the one point-blank question. This applies just as much to doctors and nurses, who must know frorri their symptoms how seriously ill they are. It is as if they knew instinctively That death is a thing to be faced when it comes, and not before. To force them to look their own tragedy full in the face would be a need- less cruelty. For these patients, there is surely a right not to know, if they prefer to remain in ignorance.
Previous page
