‘‘ Coming Out’’ as Patients 171
those are somewhat true. The car accident was minor. But misrepresentation like that is akin to lying....
Hence, these physicians raised questions of definitions of sins of omission versus sins of commission, and of‘‘ partial’’ truths. Some have decided to fib to their patients. When asked, Stuart dissembled to a patient:‘‘... he said,‘ I just want to know: You’ re going to be around, right? You’ re not sick or anything?’ I tacitly lied: I’ m not sick.’’’
In part, Alex feared that patients might sue; and disclosure could hurt his field as a whole.‘‘ I would cause sensationalism in the papers. It would not be good for my profession.’’
Still, generally, many patients found out last, often‘‘ only after the doctor dropped dead.’’
In all, these doctors shed light on the intricacies involved in balancing ethics against interpersonal aspects of doctor-patient relationships and communication. Patients faced dilemmas of whether to comment on a doctor’ s condition either implicitly or explicitly. Doctors had to decide whether, and what, to disclose.
Across diseases, similar quandaries arose of whether, what, when, and whom to tell. Yet with HIV, given its infectivity, patients wondered if they had a right to know. Still, they sensed that to ask directly might be taboo.
These narratives raise larger important questions( e. g., how ethical issues are approached and handled within the social and psychological nuances and complexities of the doctor-patient relationships that are often built on fragile trust). Doctors felt that a patient did not have a right to know the doctor’ s health status generally, unless it in some way threatened the patient’ s health. But what felt psychologically appropriate could conflict with what was considered ethical. Even if disclosure were ethically unnecessary, trust and closeness could make nondisclosure awkward. Silence can foster distance and tension. Hence, doctors may disclose, even though they are not ethically required to. At times, physicians disclosed to help patients cope. Divulgence may be more beneficial for certain diagnoses or types of disorders than for others. For example, former substance abusers often treated substance-abusing patients, and drew on personal experiences to be more effective( 5). Physician disclosure can potentially strengthen patient-provider bonds, and thus treatment alliances. Yet even here, clinicians faced dilemmas of how much and what information to