by Craig Klugman, Ph.D.
The Texas Senate just passed a new bill (SB 25) that would shield doctors from a lawsuit if a baby is born with a disability even if the doctor knew of the concern and chose not to tell the parents. Opponents of the bill say that it permits doctors to lie to their patients if the doctor believes that knowledge might lead the woman to choose an abortion. The Houston Chronicle reports the bill’s aim is to “chip away at abortion rights.”
The Texas law does not go as far as a 2015 Arizona law that mandated physicians lie to patients by telling them that an abortion can be reversed. The new Texas bill would “allow” doctors to lie to patients and shield them from lawsuit unless the patient could prove gross negligence. The burden is on the patient to prove that the doctor should not have lied.
One of the first rules of professionalism that I teach in undergraduate and medical school bioethics courses is that in general, you never lie to the patient. Telling the truth is a bedrock concept necessary to respect patient autonomy. In order to make decisions, patients need to have knowledge of their condition and their treatment options (risks, benefits, and alternatives).
There are a few circumstances in which lying to patients is ethically acceptable: If the physician has strong reasons to believe that information would push the patient to do harm to him/herself or others, or if the family has requested that a patient not be told information because of cultural practices and the patient has agreed that she/he does not want to know the news. A “benevolent deception” may be told in a situation where a patient with dementia keeps forgetting a painful truth and every time he/she is told that information again she/he experiences fresh grief and suffering. The deception in this case is more compassionate than the truth. For example, a patient with dementia does not remember that a loved one died. Every time she is told about the death, she experiences fresh grief until she forgets about the death again. The benevolent lie does not affect health decisions that need to be made, but it does prevent repeated suffering. Even then, the information should be told to the designated patient decision-maker and the patient may be told some of the information at moments when the patient has clarity.
The goal of this bill, however, is not to bend the truth with the patient in mind, but simply to permit the physician to make a value judgment on the patient’s beliefs and potential actions. The bill would permit doctors to purposefully mislead the patient with no regard for the patient’s autonomy or best interest in an attempt to make a particular decision favored by the physician—to choose against abortion.
While the bill, if enacted into law, would permit doctors to make paternalistic choices for their patients, ethically the action would still be wrong. This is a situation where a potential law and ethics depart widely. The bill still needs to be taken up by the Texas House of Representatives and the governor. If it passes, any physician who might choose to lie to a patient under this law should be reported to the Medical Board for lying and misleading patients.