Running head: TELLING THE TRUTH TO A PATIENT WITH DEMENTIA

Telling the Truth to a Patient with Dementia Name: Institution: Instructor: Date:

TELLING THE TRUTH TO A PATIENT WITH DEMENTIA

Abstract This article is meant to discover what patients suffering dementia feel is wrong with them. The information that has been disclosed to them, who have disclosed and what they may wish to know concerning their illness. Background information Revealing the truth to a patient about dementia diagnosis should be the usual practice. It should be done sensitively and in a focused way that avoids unnecessary despair. When disclosing the truth, the disease should be mentioned by its name, future expectations and the fact that though the condition is incurable, its symptoms can be treated. However, diagnostic truth-telling allows the patient with dementia and family the opportunity to plan for the future. Common questions What are the implications of a person suffering dementia not knowing or knowing their

diagnosis? What impact might the expectations and values of a given culture have on disclosing

diagnosis?

TELLING THE TRUTH TO A PATIENT WITH DEMENTIA

Introduction Should physicians not reveal the truth to patients in order to relieve their anxieties and fears? It may appear to be simple, but really a hard question. Dementia is a syndrome, usually of a progressive and chronic nature. It is associated with the decline of cognitive functions, deterioration in language skills, emotional control, and social behavior (Saunders 2011). It is an Alzheimers disease that secondarily or primarily affecting the brain. Although it may start at any age, it most frequently affects the elderly people. Trying to assist people with dementia is not only a challenge to professional skills of physicians but also confronts them with hard questions about the limits of medical paternalism and individual autonomy, persons dignity and their best interests. Although a recent research revealed that physicians rarely inform their patients concerning their diagnosis, they almost never inform them about their prognosis. Revealing the diagnosis information depends on the level of impairment. About 57-83 % of dementia sufferers relatives do not wish their patients to be told about their diagnosis, though about 70% of the relatives want to be told about the diagnosis in case they have disorders themselves. What do dementia patients wants to know? This study is aimed at exploring what dementia patients think is wrong with them, what have been revealed to them by their doctors, and what they may want to know concerning their illness. The study involved thirty patients comprising of 10 men and 20 women where 19 were outpatients and 11 in-patients with ages raging from 63 to 92 years. The cognitive states of the participants were assessed using Mini-Mental State Examination (MMSE) and their scores

TELLING THE TRUTH TO A PATIENT WITH DEMENTIA

ranged from 7 to 29. They all answered a set of questions regarding information they had received concerning their illness. What they think was wrong with them? About 47% adequately described their main symptoms and gave the correct diagnosis. Majority complained about their memory problems, but nobody used the term dementia. The rest gave implausible answers such as loneliness, stomach upset and old age. What have been revealed to them about their illness? Approximately 67% revealed that they have ever discussed their illness with anybody. In five cases, the information was provided by nurses and friends but not by family members. Only one person disclosed that she had been told about her diagnosis. Other three participants reported that untrue explanations were allegedly given to them by doctors. Two participants were rather insulted by being told they were mad while two were unable to remember or understand what informers had been explaining to them. What would they like to know? Almost 67% wanted to know about the problem they were undergoing, five were interested on how they can improve their conditions, ten wished to know their diagnosis while one wanted to know the causes of the disorder. Another 30% did not want to receive any information relating to their illness or what is wrong with them. Disclosing the Diagnosis and ethical codes Guidelines concerning diagnosis disclosure may be differently interpreted as they are equivocal. Doctors should practice their art with holiness and purity which implies veracity.

TELLING THE TRUTH TO A PATIENT WITH DEMENTIA

They should follow the system that is beneficial to patients and abstain anything that is mischievous and deleterious. International Code of Medical Ethics demands honest dealing of colleagues and patients by physicians that are in connection with professional misconduct and competence rather than telling the patients what is wrong with them. According to World Medical Association, it is the patient's right to accept or refuse the treatment after receiving the truth about his or her illness. The world Psychiatric Associations of Hawaii declaration (1977/83) says that, patients should be informed about the nature of therapeutic, condition, procedures and possible alternatives. Information should be disclosed in a considerable way and patient allowed to choose between available and appropriate methods. Ethical theories and disclosing the diagnosis This issue has been addressed by two schools of thoughts that are deontology and consequentialism. Deontology insists that it is the moral duties of clinicians to tell the truth. It is the right of competent patients to know their diagnosis information and the truth regardless of the consequences (Turley 2014). Consequentialism on the other hand, insists that decision to disclose the truth should depend on the clinical situation. Physicians should decide the least harmful course of action with best results for patients. Argument in favor of truth-telling According to Childress and Beauchamp, the following are the main obligating veracity arguments. Respect for autonomy, need for trust in patient/doctor relationship, and reciprocal obligations acknowledgement, promise keeping and fidelity. Limited truth-telling or lying arguments

TELLING THE TRUTH TO A PATIENT WITH DEMENTIA

The following are the prevailing arguments of limited deception and disclosure according to Beauchamp Childress. Patients being unable to understand the information, therapeutic privilege and patients are unwilling to know the truth concerning their condition. Conclusion Veracity is a difficult virtue in terms of fulfilling an obligation. It has been difficult to understand how much information should be given to a patient and reconcile the conflicting principles. Sometimes it becomes difficult to balance paternalism and autonomy. The literature review discloses that it is unclear in dementia whether knowing the truth is the right of a patient. This study suggests that dementia patients should be asked whether they are willing to know more about their diagnosis or not. Patients should be approached individually and their choices respected despite the level of impairment. However, the impact of telling or not telling the dementia patients the truth is unknown and calls for further perspective studies.

TELLING THE TRUTH TO A PATIENT WITH DEMENTIA

References Coon, D., & Mitterer, J. O. (2014). Psychology: a journey (5th ed.). Belmont, Calif:

TELLING THE TRUTH TO A PATIENT WITH DEMENTIA

Wadsworth/Cengage Learning. Saunders, C. (2011). What nurses know-- multiple sclerosis. New York, NY: Demos Health. Turley, J. (2012). Alzheimer's will I be next?. S.l.: LifeLinks.