The right to know or the right to live?

Honesty in relations with the client is one of the basic principles on which Western civilization in general and medical practice in particular is built. This principle is based on moral paradigms: a lie is immoral, a person has the right to be informed about everything that applies to him. In addition, an honest message has an advantage over a false one from a pragmatic point of view: a person must imagine the situation in its true light and in its entirety in order to decide how to behave, in order to make a personal choice, to which he is certainly entitled. .

But there are cases that call this principle into question. If a person finds himself in a situation that, when viewed from the outside, seems hopeless, and he himself perceives it as such, he drops his hands and develops a feeling of helplessness. As a result, he, as a rule, is not able to make any effort to try to change something. But the so-called objective assessment of the situation usually does not take into account the potential of its dynamics – which may well arise with a creative approach to solving a problem and, in general, with the active behavior of a person who finds himself in this situation.

This is especially true for human health. Preservation of health and its restoration in the course of treatment largely depends on the potential capabilities of the body, on immune functions, and they, in turn, are largely determined by the active search behavior of a person *. An international study was recently conducted on cancer patients **, which were recognized as hopeless and, according to the medical prognosis, were soon to die. But they survived and even recovered from the disease. The researchers found that active behavior was common to all survivors: active participation in the treatment process (search on the Internet for information about the disease and new approaches to its treatment, search for qualified doctors, etc.), active participation in social life, including helping others people. Many of these patients were aware of the hopeless prognosis, but the feeling of helplessness provoked by this information aroused their protest and became an incentive to resist.

Much more often, after such a forecast, people passively await their end – and actually die. The message of doom disarms a person in the face of his illness. Such a message can be fatal even in the case of a medical error – i.e. unless the person actually has cancer! And if patients were set up by doctors and psychologists to fight and were, for example, familiarized with the results of the above-mentioned study, the number of survivors could greatly increase.

But for this, doctors must abandon the idea that the patient, as an independent person, must be fully aware of the prognosis of the disease. No one has complete information about this, because the course of the disease depends not only on the indicators at the moment, but also on the life position of the patient himself. And even if a person still dies from the disease, an active life in the time left to him is filled with meaning and hope. Familiarizing the patient with a fatal prognosis is not a defense of his human rights, but a defense of the doctor from accusations of hiding the truth. This attitude must be changed at the level of the whole society. The right to life is superior to the right to such knowledge that may endanger life.

* More details: V.S. Rotenberg, V.V. Arshavsky. “Search activity and adaptation”, 1984.

** M. Frenkel et al., in Support Care Cancer, 19: 1125–1132, 2011