Read: The Ethics of Veracity and Its Importance in the Medical Ethics The ethical principle of veracity refers to truth-telling, honesty, as well as integrity in all actions. While veracity has a legal basis in court processes where witnesses are sworn to tell the whole truth and nothing but the truth, and a lack of honesty may lead to illegal activities such as fraud, this activity emphasizes the ethical aspects which are not based on law. Truth-telling is linked to the patient's right to autonomy as well as beneficence and nonmaleficence. The reading for this assignment does a nice job of exploring a variety of healthcare-related aspects to truth-telling including culture. I know I have been placed in ethical dilemmas when the patient's culture dictated that the oldest male relative made all decisions and the patient had no voice. Case Study Liz is a medical assistant for a single MD medical office. One day after seeing a long-time elderly patient, the MD comes to you at the desk. He tells you that Mrs. Smith's family does not want her informed that she has terminal cancer and does not have long to live. Liz looks surprised because she is aware of and follows the ethical principle of autonomy. Treatment decisions require knowledge of benefits and risks to be able to make autonomous choices. The MD notices her surprised look as he goes on to say that it is part of her culture and that although she is competent, he has to respect her cultural norms. Later, as Liz is assisting Mrs. Smith into her car to drive home, she turns to Liz and tells her that she thinks everyone is keeping the truth from her. She looks Liz in the eye and asks her if she is dying. Determine your response if you were in Liz's shoes. Include each of the following points in your assignment: . Summarize the important aspects of this case . Briefly describe how the ethical principles of veracity, autonomy, and beneficence would dictate your response . How does the need for respect for culture impact this case? . What will you say to Mrs. Smith . Support your response with ethical principle(s)1. Introduction The debate on the issue of truth telling is at the core of the contemporary bio- medical ethics. There is delicate interplay between autonomy and beneficence which made some differences in truth telling between the cultures, from the in medicine [1]. Truth-telling in medicine is a broad area and often encompasses several ethical issues. These issues include the right of patients or their families to receive information about their diagnosis and illness [2]. The standard of profes- sional candor with patients has undergone a significant change over the past 30 years. Independent of their obligation to disclose information necessary for in- formed consent, physicians are increasingly expected to communicate important information to patients that is not immediately related to treatment decisions [3].2. Veracity as a Virtue In the beginning we have to know what is virtue; then what is the meaning of 2019 194 Open Journal of Nursing A. B. Amer veracity. A virtue is a feature of one's character: a disposition to act in a certain way in relevant circumstances that will make you a good person [4] [5]. What is veracity? In concise oxford dictionary veracity is conformity to facts, accu- racy, habitual truthfulness [6]. Henry Sedgwick's nineteenth-century observa- tion still holds: "It doesn't clearly agreed whether veracity is an absolute and independent obligation, or a special application of some higher principle". G. J. Warnock's later assessment was that veracity is an independent principle and virtue that ranks in importance with beneficence, nonmaleficence, and justice, we view obligations of veracity as specifications of more than one prin- ciple [1].3. Veracity in the Health Care Setting It refers to comprehensive, accurate, and objective transmission of information, as well as to the way the professional fosters the patients or subjects under- standing. In this regards, veracity is closely connected to respect of autonomy [1]. Bacon's comment that "knowledge is power but honesty is authority", is particularly applicable to doctors [7].4. History of the Ethics of Veracity The historical medical codes addressed issues like not doing harm, not taking life, not engaging in sexual acts, not revealing secrets, but said little or nothing about telling the truth and avoiding lie [6], the codes of medical ethics have tra- ditionally ignored obligations and virtues of veracity [1]. The historical absence of a truth requirement in medical ethics has much to do with the moral assump- tions of ancient cultures. In earlier cultures it was an ideal to treat other persons as a father treats a child. Paternalism was something virtuous; the opposite was to treat the other as a slave. In early Greek culture, the good doctor or the good ruler treated the patient or the citizen as a son or daughter rather than a slave. He did what was best for the "child" but without ever asking for his or her con- sent [6]. The Hippocratic Oath does not recommend veracity nor does the Dec- laration of Geneva of the World Medical Association. The principles of Medical Ethics of the American Medical Association (AMA) from it is origins until 1980 made no mention of an obligation or virtue of veracity, giving physicians unre- stricted discretion about what to divulge to patients [1]. The 1980 revision rec- ommended that a physician shall deal honestly with patients and colleagues and strive to expose those physicians deficient in character or competence, or who engage in fraud or deception. This first official reference to veracity in physician codes remains a very abstract one, and is more concerned with failures of ho- nesty among colleagues than with truth telling to patients [6] and the 2001 revi- sion indicates that physicians shall "be honest in all professional interactions". Despite this traditional neglect of veracity, the virtues of candor, honesty, and truthfulness are among widely and deservedly praised character traits of health professionals and researchers [1].5. Importance of Ethics of Veracity in the Medical Ethics When physicians communicate with patients, being honest is an important way to foster trust and show respect for the patient. Patients place a great deal of trust in their physician, and may feel that trust is misplaced if they discover or perceive lack of honesty and candor by the physician [7]. Today, patients have the right to know their health information, and physi- cians are obliged to provide it. It is expected that patients will be informed of their medical condition regardless of the severity or prognosis [8]. What is of importance is the way that information should be given to patients. A good truth telling technique could have positive effects on their prognosis and quality of life, reducing emotional pressure and maintaining their sense of hope [9]. Truth telling does not mean that health care professionals must simple disclose all the information bluntly in one session. It is very important while sharing medical information nothing remains uncertain. Doctor has to be aware of the way that truth is affecting each patient and respond in an empathetic and atten- tive manner [10]. Telling the patient the truth ensures that the correct informa- tion is given and correct choice for the patient is made. Explaining the truth to the patient is a very complicated process and the physicians experience is very important, a physician who has developed communication skills and knows approaches for informing can give desired messages that give the amount of information that the patient wants and when the patient is ready [11]. Truth telling fosters trust in the medical profession and rests on the respect owed to patients as persons. It also prevents harm, as patients who are uninformed about their situation may fail to get medical help when they should [12]. Truth-telling obviously is a necessary condition of medical practices but could at times be withheld in order to avoid another vital interest that may help in promoting the healing process which the intervention hopes to achieve [13]6. Justifying Less than Full Disclosure Withholding information from a patient does not always undermine veracity or violate the truth principle. Sometimes patients request that information be withheld. Doctors sometimes are asked to make decisions for patients without communicating relevant information. Ordinarily, respecting such requests vi- plates no major ethical principle: neither autonomy, nor truth, nor beneficence [6]. According to Korsch and Harding, "The information a doctor gives a patient should be tempered by who the patient is and what he or she is ready to hear". In addition, many contextual variables-the doctor, the patient, the condition, the time frame, the need for privacy, the patient's expectations, the complexity of the condition, the implications of illness, and the nature of the interaction-influence the sharing of information [15]. So clinical judgment is always required because in some cases, even a reluctant and intimidated patient who requests not to be informed, needs to know some truths. Not knowing may create a serious danger 196 Open Journal of Nursing A. B. Amer to self or to others, and if so, the patient's request that information be withheld cannot be respected because it violates the core principles of beneficence and nonmaleficence [6].The following Case is an example: a 65-year-old man comes to his physicians with complaints of abdominal pain that is persistent but not extreme. Workup reveals that he has metastatic cancer of the pancreas. The man has just retired from a busy professional career, and he and his wife are about to leave on a round-the-world cruise that they've been planning for over a year. Should you tell him his diagnosis? Discussion of the case Several factors tempt one to withhold the diagnosis, and these should be rec- ognized. One would be the concern that the patient would suffer psychological harm that would interfere with his planned trip. There is little empirical evi- dence that this occurs, and lacking some compelling reason to think it would occur with this man, it is insufficient grounds to withhold information. To the contrary, sensitive disclosure would allow the patient and his wife to decide if the trip is still important to them, versus seeing their grandchildren, for instance, and would spare the patient the inconvenience of suffering advancing symptoms while traveling, perhaps necessitating emergency care in a foreign locale. Finally, physicians should not confuse discomfort at giving bad news with justification for withholding the truth. In this case, the man should be told his diagnosis, prognosis, and treatment options [7].7. The Ethics of Veracity and Cultural Influence Cultures that place a higher value on beneficence and nonmaleficence relative toautonomy have a long tradition of family-centered health care decisions. In this collective decision process, relatives receive information about the pa- tient's diagnosis and prognosis and make treatment choices, often without the patient's input [16]. Family members acting as surrogates for their loved ones often request that the truth be withheld, usually to prevent what is perceived as possible terrible harm to their loved one. Physicians may have to work closely with these family members to make sure that their patients are well cared for and their autonomy respected while acknowledging the critical role that loving family members play in the process of achieving desirable care [17]. 8. Conclusion The health care professionals needs more awareness, and training to increase their skills in the ethics of veracity and also the communication skills especially in the context of breaking bad news in telling the patient the truth about diagnos sis, treatment outcomes, and prognosis of any serious illness; such skills have been found to improve doctor-patient relationship, satisfaction with care and patient health outcomes