Truth-telling and deception in the management of nonorganic vision loss

• Published in: Canadian journal of ophthalmology 2016-10, Vol.51 (5), p.390-392
• Main Authors: Wandling, Lara J.G., MD, Wandling, George R., MD, Faith Marshall, Mary, PhD, Lee, Michael S., MD
• Format: Article
• Language: English
• Subjects: Adult; Child; Deception; Health Care Surveys; Health Promotion; Humans; Internal Medicine; Male; Middle Aged; Neurologists - ethics; Ophthalmologists - ethics; Ophthalmology; Physician-Patient Relations; Practice Patterns, Physicians; Surveys and Questionnaires; Truth Disclosure - ethics; Vision, Low - diagnosis; Vision, Low - therapy; Visual Acuity
• ISSN: 0008-4182; 1715-3360
• DOI: 10.1016/j.jcjo.2016.01.002

Abstract Ophthalmologists face an ethical dilemma when communicating with patients diagnosed with nonorganic vision loss (NOVL): Either reveal the diagnosis of NOVL, risking a potential angry breakdown in trust, or offer reassurance without discussing the full truth. This dilemma reflects the ethical obligation of physicians to weigh the principle of respect for autonomy against the principle of beneficence. We conducted a survey of physicians who specialize in neuro-ophthalmology to examine professional perspectives regarding diagnosis and management of NOVL for adults and children with the goal of promoting discussion of the ethical implications for clinical practice. Survey results showed that using deceptive methods to prove visual acuity was viewed as ethically appropriate (99.2%). Communication involving the disclosure of a NOVL diagnosis was not favoured in adults (11.4%) and children (4.9%) without a perceived secondary gain. In contrast, communication involving the disclosure of a NOVL diagnosis was favoured in adults with a perceived secondary gain (49.2%). Treatment of children with a placebo (3.8%) was favoured more highly than placebo treatment of adults (1.6%). Ophthalmologists adapt their disclosure of diagnoses and management to their patients, which imposes some limits on truth-telling. Only a minority of ophthalmologists disclose the diagnosis of NOVL. The best method for communicating the diagnosis of NOVL will need to balance ethical considerations with therapeutic benefit. When the therapeutic benefit of deception is unproven, physicians have an ethical duty to disclose.