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It’s really only a matter of confidence—the question is with whom should this confidence be kept?
1. A patient should have confidence he/she will recover. Faith.
2. A physician should tell the patient the truth in full confidence. Accuracy.
3. A physician [and family] should hold the truth in confidence. Guardianship.
These are three very different definitions of confidence, yet each has its own legitimate argument with regards to patient- physician relationship.
The nature of the culture of the patient is an important factor in deciding the value of truth and delegating confidence to the appropriate party. For example, a culture which values knowledge, liberty, and personal expression will require that accuracy be observed (number 2), as a patient will expect to choose how to be treated. Whereas, a culture placing high value on obedience and unquestioned trust would be most accepting of guardianship (number 3), and a patient expects to be told what to do. Faith (number one), however, is the only universal practice. In every culture, people are willing to aknowledge the influence that it has on the patient- and all have heard stories of the body failing due to loss of hope.
I personally believe that the first, Faith, is the most important definition of confidence. Above all, a person must honestly believe that they will survive in order to do so. If there is not an immediate risk of fatality, i.e. less then a year or two to live, then a physician should consider the advantage of mental healing.
One also should consider the benefit of lying about treatment. If a physician tells a patient that a treatment is 95% successful, whereas it is really only 70%, it would increase the spirits of the patient, and that has a significant success rate. There is power behind positive thinking and sometimes, ignorance is bliss.
I would also like to stress the accountability of the patient’s ability to express their...