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"Should health care professionals ever withhold the prognosis 
from dying patients (12 years old to adult)"

Opening Arguments

    Pro Side:

We feel that physicians do have the right to withhold prognosis in certain cases because experts have proven that in many cases disclosing too much information is more harmful and dangerous to the patient than simply addressing immediate problems and concerns.

a.) According to a document that we acquired from the Department of Medicine at Genessee Hospital in Rochester, New York….

      "Interviewer: Is there ever any justification for not being honest with someone who is dying, about the fact that they are dying?"

      "Ross: You have to be honest, but you don't have to be totally honest. You have to answer their questions, but don't volunteer information for which they have not asked, because that means that they are not ready for it yet. Without miracles, there are many, many ways of helping somebody without a cure. So you have to be very careful how you word it. And never, ever take hope away from a dying patient. Without hope nobody can live. You are not God. You don't know what is in store for them, what else can help them, or how meaningful, maybe the last six months of a person's life are."

B. Con Side:

One example of a well-known organization that is closely associated with dying teens and children is the Make-A-Wish Foundation. This organization makes it a point not to tell the children, although the majority of the children already know all facets of their disease. A lot of the children reportedly tell people at the foundation about their condition, in sincere and honest terms. And according to the Make-A-Wish foundation, children that are not told are able to read their parents actions and emotions and realize what is going on.

In one study that I read about leukemia patients, children who were not told had strong feelings of being abandoned or isolated. One girl said, " Daddy doesn't care about me. I know he comes to visit me practically every day, bit once he comes he always seems so far away. It's like he can't wait to leave again." According to experts, this fear of abandonment stems from the fact that the parents are distancing themselves from their children.

In Maria Nagg's 3 stages of Death Comprehension, Stage 3 (9-10 years old) view death as personal, universal, final, and inevitable. I believe that this is the same way that most adults see death as well. When children learn ,ore and more about their particular illness, they become more sophisticated. For example, children learn the names of various treatments, drugs, changes in body, etc.

Another aspect of adolescent competence and right to choose and have their prognosis revealed to them comes from our interpretation of the American Medical Association's Principles of Medical Ethics. The first point I want to consider here is that "The physician shall be dedicated to providing competent medical service with compassion and respect for human dignity." The second point listed here is 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." I think that this all relates to my original statement that adolescents understand because they have advanced cognitive thinking capabilities.

Patients have a right to know the truth. They may want to take care of such things as wills, or future guardians for their children, or they may have last words to say to loved ones or friends; thus this is our third reason why we feel it is wrong to not disclose the full prognosis to a dying patient.

Rebuttal of Points Made By Both Sides:

    Pro Side Rebuttal:

The main point that we attempted to make in the rebuttal was that we were not arguing for a withholding of prognosis on a wide scale term, but rather to point out that there were circumstances than made the nondisclosure relevant and practical. We also attempted to point out that we were not trying to provide a blanket or "all-inclusive" answer to a problem, we just wanted the audience to realize that there were special cases that were the exception to the rule and we wanted people to see the issue form that viewpoint. Also we argued against an example that they gave of a 17 year old boy who had always known of his terminal condition and felt better because that he had known and was able to deal with it. Our argument was that this was great for that particular individual , however what about those young adults or children that can't handle it? Once they know everything there is no way of taking back that knowledge … it is something that they will always know and be thinking about on some level every day until they pass away.

    Con Side Rebuttal

The main point that we wanted to argue against was that we were not advocating for removing hope from the patient. We feel that hope is very important as does the other side in the well-being of a patient, we in no way meant to come across as being desensitized towards the patients feeling. In addition we want to emphasize that the patient who is terminally ill should be told gradually, not abruptly or broadly.

    Questions Posed By the Class During the Debate

This section of the debate was rather long and extensive and it was not really possible for us to be able to write down all of the questions and responses that were asked and given. However, questions and criticisms that were posed to us will be addressed in a later section.

    Concluding Remarks

    Pro Side Closing Remarks

Our main point in closing was that knowledge is seen as a powerful and dangerous thing. From our text book it was mentioned that when a patient claims that he or she is seeking the plain truth, often times this means that the truth is the last thing that the patient really wants. Another philosophical concept that we wanted to leave the class with was that the expression "to have the right to the truth is unmeaning, rather a man has a right to his own truthfulness, a subjective truth in his own person."

Next, we gave a personal example from someone in our sides family who responded the way that many scientific and psychological experts predict. The person upon being told of their complete diagnosis was not really able to handle it so well and this person's health begin to decline as if their will to live was no longer as great as it was before they found out. We also gave examples of what various people in the medical field felt about our debate topic and how these real life situations really seem to work in the real patient situation. We presented information from physicians, chaplains at local hospitals, ER Nurses, ICU Nurses, CCU Nurses, Life-support Nurses, and hospital security officials. Most agreed that sometimes not telling the patient every single detail about their condition is in the long run what is best for them. These real life experts gave personal testimony of what can happen when a patient can not handle the disclosure of their full prognosis.

The final thing we did was to reiterate our three main points and why we believed that they were important. Our first point was that physicians have the right to withhold prognosis because health care workers have proven that disclosing too much information is more harmful than simply addressing immediate concerns and discomforts. Our second point was that physicians have sworn in the Hippocratic Oath to "do no harm" unto patients and this includes psychological trauma. Thus many physicians feel it is their duty to not disclose too much information for fear of inflicting psychological harm unto their patients. Our third and final point was that physicians have the right to withhold prognosis in those cases where competency is questioned and where the patient seems to be unable to make a well-informed decision on their own behalf (used to illustrate an extreme case, but to show there are cases when nondisclosure is appropriate).

    Con Side Closing Remarks

The main ideas we wanted to end the debate with was a reemphasis of our three main points which we felt sufficiently expressed all those ideals that argued most strongly for our viewpoint. Our first main point was that the "failure" that occurs in disclosure results not from what or how much the patient is told but rather the way in which they are told of their condition. Our second main point was that we felt adolescents should be told the entire truth about their condition because they are able to handle it due to their possession of advanced cognitive thinking ability. Our third main point was that people have the need to know the truth in order to deal with issues like wills, child care once they are gone, saying good-bye to loved ones, etc. It was these three points which we felt argued the most strongly for why the patient always has the right to be told their prognosis when they are dying.

    Questions and Comments That We Received From The Class

The questions and comments that we received as feedback from the class were really helpful in showing us those aspects that we did well or poorly as well as showing us things that we should have possibly considered more. In this section we wish to share a few of the comments that we received so that everyone has the chance to think about these new ideas and possibly get even more out of the debate. One comment we received was that the pro side should have provided more points to support their arguments. We were (according to the guidelines) limited to presenting only the main three points that we felt best supported our argument. It was for this reason why we did not share more, and there were more good reasons we could have used, it was just that those were the three that we thought were the best. Another criticism was that we should have used more props (etc. posters, etc.) in our debate. Our response to this is that the two opposing sides had to maintain strict guidelines about not discussing the debate before we presented the debate. Thus it would have been difficult to have known what to make posters of without breaking this "gag" order imposed upon us. In addition, we don't feel that in a debate posters and props are as important as they would be in presentations. We just wanted everyone to understand that what we were doing was a new format for the class, and there would be distinctive differences between the regular presentations and our debate. Another comment was that an audience member felt that we did not sufficiently address long-term illnesses. We apologize if there was any misunderstanding, but we thought (it is difficult to remember since in a debate so much is played by ear) that both sides addressed long term terminal disease as well as short term terminal illnesses. One thing that seemed to be the most common advice of things that we should have done differently was that we should have included more on informed consent. In retrospect, we agree that this should have played a larger role, but when we were compiling information for our arguments neither side came across it. We all wish that this point could have been included since it was relevant to what we were discussing and we thank those individuals that pointed this out to us.

The majority of the class seemed to enjoy the debate since it encouraged so much class participation as well as caused each individual to think more about their own views on the subject. The consensus was that the debate was well organized and also presented well. We appreciate all comments made, whether they were good or bad, and we hope that we have addressed the majority of your queries here in this portion of our debate outline. We also wanted to add that the response to our debate on the listserv has been phenomenal and we hope that everyone keeps asking us more questions about this topic.

    Sources Used In This Debate

Campbell, Steve. Personal Interview. 20 Feb. 1998.

Carmichael, Chaplain. Personal Interview. 20 Feb. 1998.

"Contemporary Health Care and the Ethics of Medicine," May 1997.


"Ethical Principles and the Doctor," Feb. 1998. Internet.

Harvey, Mark (Chaplain). Personal Interview. 19 Feb. 1998.

ICU/CCU/ER Nurses. Personal Interviews. 19 Feb. 1998.

Jose. (VA Police Officer). Personal Interview. 20 Feb. 1998.

Legal Issues In Psychiatry. Author unknown. Section 52.1

Penn, Dennis. Personal Interview. 20 Feb. 1998.

Quill, TE. "Bad News: Delivery, Dialogue, and Dilemmas," Arch

Inernal Med (7FS) Mar. 1991: 463-8.

Ross, Dr. Elisabeth-Kubler. Internet Interview.

UK Doctors and Nurses. Personal Interview. Feb. 21 1998.