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Experts from disciplines such as medicine, sociology, nursing, Philosophy or theology participated in the seminar 'Ethical dilemmas in communicating the truth to the seriously or terminally ill'. The activity was organized by the transversal group of research 'Philosophy and palliative care', of the Institute for Culture and Society (ICS).

The activity, moderated by Nunziata Comoretto, bioethicist at the Pontifical Academy for Life, was attended by Carlos Centeno, researcher principal of the ATLANTES Program of the ICS and director of the Palliative Medicine Unit of the ICS. Clínica Universidad de NavarraTomás Trigo, professor of Moral Theology; and Rogelio Altisent, from the Chair of Professionalism and Clinical Ethics of the University of Zaragoza.

Narration of the experience staff of the palliative specialist in a complex case.

First, Carlos Centeno narrated his experience staff as a Palliative Care specialist in a clinical case of a patient with advanced cancer.

Dr. Centeno reflected on the dilemmas he faced in this case, both in terms of helping the patient to adapt to her condition, as well as the relationship with the professionals of the other disciplines who attended her.

Nunziata Comoretto insisted on the complexity of the case "not only because of the ethical and psychological difficulty of giving bad news, but also because of the difficulties in administering information on the part of the professionals; the family, who put up barriers or did not support; and the patient herself, who had difficulties in coping with the status". 

Truthfulness: telling the truth when, to whom and how to tell it.

Professor Tomás Trigo then shed light on topic from anthropology and ethics. In particular, he insisted on the need to tell the truth to the patient in cases such as this in order to get him out of self-deception.

The fundamental anthropological question core topic ," he said, "is the dignity of the person. We are not just dealing with a sick person who needs to be cured; this illness is part of the context of his 'being a person', which involves other dimensions in addition to the health of the body".

He emphasized the relevance of the virtue of truthfulness: telling the truth when, to whom and in the way it should be told. "The knowledge of truth is a good. And the truth about a patient's status that allows him or her to decide about his or her future is important. That person has a duty and a right to know the truth because he or she has to make decisions about his or her life and needs to have the relevant data to do so."

However, Professor Trigo stressed that there are various contexts that can make it difficult to reveal the truth. On the one hand, some patients are willing to know it, but may not understand or clarify it; in other cases, they directly express their will not to know it and this must be respected by law. "In that case, you have to talk to a family member manager who can make the appropriate decisions," he recommended. Another scenario is when the patient wants to know the truth but that can lead to depression or other medical problems. Faced with this, Tomás Trigo stressed that "even if there are negative repercussions, you cannot hide the information. The challenge will be how to communicate it".

With respect to family members, Professor Trigo commented that some do not want the patient to be report because "they think it is best for them to die without being aware of their status", which in his opinion is a mistake because "they cannot make the family, professional, spiritual, etc. decisions that correspond to them".

With respect to physicians, he stated that "some think that this right of the patient is an interference in the practice of their profession," while others fear producing frustration in the patient and, frequently, there is a reaction of avoiding communication with both the patient and his or her family.

Approach difficult cases: reflection staff, contrast with other colleagues and the enquiry to a committee of ethics.

Rogelio Altisent first reviewed the elements of clinical ethics: ethics as intuitive moral judgment -knowledge spontaneous moral judgment -; as academic discipline - bioethics -; professional deontology - a set of rules and values defined by a professional corporation through a code -; and law - the healthcare rules and regulations -. "There are three levels of requirements: ethics staff is more demanding than deontology, and deontology is more demanding than law," he said.

With respect to the case addressed in seminar, he distinguished two ethical issues involved: "The professional attitude and an operational issue, where communication with the patient is situated".

The quality of care," he added, "is directly related to the commitment of the professionals, which has to do with their attitude. This is one of the messages that must be conveyed in the ethical training . On the other hand, there are dilemmas, situations that raise complex doubts that cannot be resolved intuitively: I know there is a right decision, but I do not know it yet. Then there are the operational issues: the know-how or know-how, which affects issues such as communication".

From agreement with the professor of the University of Zaragoza, it is important that professionals are trained for this process: "You can learn to tell the truth, you can learn to give bad news, and you have to be trained for it in the same way as to read an X-ray".

Finally, he recalled that in the most difficult cases related to clinical ethics it is necessary to climb a three-step ladder: firstly, reflection staff, based on the principles of bioethics, consideration of virtues...; secondly, consulting other colleagues or the rest of the team to glimpse new perspectives; and finally, consulting an ethics committee .