Physicians' attitudes toward using deception to resolve difficult ethical problems

JAMA. 1989 May 26;261(20):2980-5.


To assess physicians' attitudes toward the use of deception in medicine, we sent a questionnaire to 407 practicing physicians. The questionnaire asked for responses to difficult ethical problems potentially resolvable by deception and asked general questions about attitudes and practices. Two hundred eleven (52%) of the physicians responded. The majority indicated a willingness to misrepresent a screening test as a diagnostic test to secure an insurance payment and to allow the wife of a patient with gonorrhea to be misled about her husband's diagnosis if that were believed necessary to ensure her treatment and preserve a marriage. One third indicated they would offer incomplete or misleading information to a patient's family if a mistake led to a patient's death. Very few physicians would deceive a mother to avoid revealing an adolescent daughter's pregnancy. When forced to make difficult ethical choices, most physicians indicated some willingness to engage in forms of deception. They appear to justify their decisions in terms of the consequences and to place a higher value on their patients' welfare and keeping patients' confidences than truth telling for its own sake.

KIE: Four hundred and seven physicians were surveyed to assess attitudes toward the use of deception in medical practice. Four ethical problems were presented that could be resolved by the use of deception. The cases involved providing a misleading diagnosis to an insurance company, telling a wife about her husband's venereal disease, deceiving family members about a death resulting from a medical mistake, and disclosing an adolescent's pregnancy to her mother. Each case was followed by multiple-choice options and a list of possible justifications. The physicians were also asked to describe their basic principles regarding the place of deception in patient care. The 211 responses are presented in graph form and commented upon. Most physicians indicated a willingness to engage in deception in some circumstances, justifying their decisions in terms of the consequences and placing a higher value on patient welfare and keeping confidences than on truth telling.

MeSH terms

  • Adult
  • Age Factors
  • Attitude of Health Personnel*
  • Beneficence
  • Bioethical Issues
  • Confidentiality
  • Deception*
  • Ethics, Medical*
  • Female
  • Humans
  • Insurance, Health, Reimbursement / economics
  • Male
  • Middle Aged
  • Minors
  • Morals
  • Parental Notification
  • Paternalism
  • Physician-Patient Relations
  • Professional Misconduct
  • Risk Assessment
  • Social Values*
  • Truth Disclosure