Experts from disciplines including medicine, sociology, nursing, philosophy and theology participated in the seminar entitled "The ethical dilemmas in delivering the truth to seriously ill or terminal patients."

The event was moderated by Nunziata Comorreto, who is a bioethicist at the Pontifical Academy for Life; Carlos Centeno, the principal investigator of ICS's ATLANTES program and director of the Palliative Care Unit of the Clínica Universitaria de Navarra, participated as a speaker, along with Tomas Trigo, Professor moral theology, and Rogelio Altisent, Chair of Professionalism and Ethics at the University of Zaragoza Clinic.

Palliative care specialist narrates his personal experience with a complex case

Carlos Centeno first narrated his personal experience as a palliative care specialist with an advanced cancer patient.

Dr. Centeno reflected on the dilemmas that this case raised, both as it relates to helping the patient to adapt to his condition and to the relationship with professionals from other areas who cared for him.

Nunziata Comoretto stressed the complexity of the case "not just because of the ethical and psychological difficulty of giving bad news, but also because of the difficulties that professionals find in managing information. Complexity is also found in the patient's family, who can put up barriers or be unsupportive, and in the patient himself, who has difficulty coping with the situation."

Truth: When to tell the truth, to whom, and how to say it

Professor Tomas Trigo then shed light on the subject from an anthropological and ethical point of view. In particular, he stressed the need to tell the truth to the patient in cases like this to avoid self-deception.

"The key and foundational anthropological question," he noted, "corresponds to the dignity of the person. This does not just involve a sick person to be cured; a disease is found in the context of a patient's personhood, which involves dimensions other than those relating to bodily health."

He emphasized the importance of the virtue of truth: when to tell the truth, to whom, and how to say it. "Knowing the truth is a good. And the truth of a patient's situation, which allows him to decide about his future, is important. The patient has the duty and the right to know the truth because he has to make decisions about his life and needs have the relevant facts to do so. "

All in all, Professor Trigo stressed that there are many contexts that may hinder revealing the truth. On the one hand, some patients are willing to know the truth, but cannot understand or clarify it; in other cases, they directly express their will not to know the truth and this should be respected by law. "In that case, a clinician should talk to a responsible family member who can make the necessary decisions," he advised. Another scenario is when the patient wants to know the truth, but it can lead to depression or other medical problems. When facing this, Tomas Trigo stressed that "although there are negative implications, the information cannot be hidden. The challenge is how to communicate it."

With respect to family members, Professor Trigo commented that some do not want the patient to be informed because "they think it's best that he die without being aware of his situation," which in his opinion is wrong because "he cannot make the family, professional, spiritual, etc. decisions that are his to make."

With regard to physicians, he noted that "some think that the patient's rights interfere with the exercise of their profession," while others fear frustrating the patient and physicians often react by avoiding communication with both the patient and his family.

Tackling difficult cases: Personal reflection, comparing notes with colleagues and consulting an ethics committee

Rogelio Altisent first reviewed the elements of clinical ethics, including: ethics as intuitive moral judgment found in spontaneous moral knowledge; an academic discipline made up of bioethics; professional ethics, which is a group of norms and values that a professional body defines with a code; and the law made up of health regulations. As Dr. Altisent noted, "Three levels of requirements are raised: personal ethics are more demanding than professional ethics, which, in turn, are more demanding than the law."

With respect to the case addressed in the seminar, he highlighted two ethical issues involved: "Professional attitude and an operational issue, where communication with the patient is found."

"Quality of care," he added, "is directly related to commitment on the part of professionals, which has to do with their attitude. This is one of the messages that must be transmitted in ethics education. Moreover, there are dilemmas— situations that raise complex questions— that cannot be resolved intuitively: Often, I know the correct decision exists, but I still do not know what it is. Then there are operational issues: know-how and expertise, which affect issues such as communication."

According to the University of Zaragoza professor, it is important that professionals are trained for this process: "One can learn to deliver the truth, one can learn to deliver bad news, and one has to train to do so in the same way that one trains to read an x-ray."

Finally, he recalled that in the most difficult cases involving clinical ethics, it is necessary to climb a three-step ladder: first, forming personal reflection, based on the principles of bioethics and consideration of the virtues; second, consulting colleagues or other team members to find new perspectives; and finally, consulting an ethics committee.