Deception

Deception

IN J Gynecol Obstet, 1992, 37: 63-64 63 International Federation of Gynecology and Obstetrics Deception ACOG Committee Opinion: Committee Number 8...

185KB Sizes 0 Downloads 20 Views

IN J Gynecol Obstet,

1992, 37: 63-64

63

International Federation of Gynecology and Obstetrics

Deception ACOG Committee Opinion: Committee Number 8’7 - November 1990

on Ethics

Deception is the deliberate misrepresentation of facts through words or actions in order to make a person believe that which is not true. Because human interaction and self-determination depend upon use of accurate information, there is a strong presumption that deception either by imparting or by withholding information is unethical. Deception, even when intended to benefit the patient, always requires justification. The rare cases of justifiable deception are more properly discussed in the context of informed consent. The following opinion is intended to address deceptive behavior which cannot be justified. It is concerned primarily with deception as a means of abusing power in a professional relationship. The primary duty of physicians is to apply their knowledge in a way that both promotes the health and respects the autonomy of their patients. Insofar as physicians possess greater knowledge about the intricacies of diagnosis and treatment, they have a fiduciary responsibility to patients. While professional knowledge gives physicians an advantage in the relationship, their professional commitment is to use that knowledge on behalf of patients. Unless physicians share knowledge and information, patiGnts cannot exercise autonomy in integrating personal values and concerns. Deception for the purpose of exploiting any imbalance in the relationship in order to benefit physicians at patients’ expense, economically or any other way, is unethical. Exploitative deception can occur in the way physicians represent their expertise to patients and in the way they communicate with patients regarding medical diagnosis and treatment. The forms deception can take include explicit lying, deception by implication, and deception by omission of information that patients need to

make decisions in their own regard. Examples of these kinds of deception can help to clarify their seriousness. DECEPTION BY EXPUCIT LYlNG

It is unethical for a physician deliberately to misstate facts, for example, to lie about his or her credentials, experience, and/or success rates. It is also unethical to misrepresent facts about conditions or treatments that apply to the patient, such as complication rates for a procedure. DECEPTlON BY IMPLlCATlON

Deception by implication is a more insidious and more frequent dereliction. An example is citing national experience and success rates in infertility procedures, implying that the same data apply locally as well. Another example of unethical behavior is alarming a patient by implication about abnormal, but relatively innocuous conditions, thereby promoting excessive diagnostic procedures, unnecessary surgery or other over-treatment. Conversely, it is deceptive to imply that a condition or procedure entails fewer risks than actually exist. DECEPTION BY OMlJSlON OF INFORMATION

Deception by omission can also be unethical. An example is failure to disclose options or information that might lead a patient to choose a different physician or a different mode of treatment. Similarly, failure to disclose a medical altemative that is therapeutically equal but less advantageous to the physician than a surgical intervention manipulates a patient’s choice and may Int J Gynecol Obstet 37

64

ACOG Committee

Opinion

expose her to hazards or expense she would prefer to avoid. Conflict of interest, or the appearance of conflict of interest, ought to be avoided insofar as possible. When unavoidable, conflict of interest that can be anticipated must be evaluated in advance and discussed with patients. If it arises in the course of diagnosis or therapy, it must then be disclosed and resolved without deception. For example, failure to disclose an interest in an imaging center or laboratory where a referral might result in financial benefit to the physician, is unethical. On the other hand deception may be involved in cases when undisclosed financial arrangements result in under-treatment of a patient. Examples of this could occur when professionals profit from inappropriately limiting care. THE RISK OF SELF-DECEPTION

involved, self-deception is an ever-present possibility. That is, relevant information potentially detrimental to one’s interests may either not be sought or may be consciously or unconsciously su pressed. To maintain professional integrity, pKysicians need to monitor regularly the motivations that underlie their policies on the disclosure of information to patients. SUMMARY

Deception is the deliberate misrepresentation of facts through words or actions in order to make a person believe that which is not true. The forms deception can take include explicit lying, deception by implication, and deception by omission of information that patients need to make decisions in their own regard. Deception intended to advantage the physician economically or otherwise at the expense of the patient is unethical.

When professional prestige or financial gain is

Copyright Q November 1990 The American College of Obstetricians and Gynecologists 409 12th Street, SW ??Washington, DC 20024-2188 Int J Gynecol Obstet 37