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Telling the Truth to the Patient with Cancer

The issue of truth-telling to the cancer patient is much like a pendulum, which can swing from a cold, nontherapeutic truth-telling to a paternalistic, unjustified truth-withholding. Several different attitudes and policies are in between; each of them stems from cultural differences in different societies and are the result of the complex interaction among patient, physician, and society. Complete, accurate, continuous information to the patient with cancer is a requirement of deontology in the United States,’ while it is far less imperative in Italy and most of the European countries. On one side, truth-withholding is deemed a limit to the patient’s freedom; on the other side, it is considered protection from an unbearable, shattering reality. What lies behind these different approaches has been discussed in previous Briefly, in the cultures more strongly bound to the Hippocratic tradition of medicine, even though information is the basis for the covenant between patient and physician, the first aim is not information but what is good for the patient (beneficence). At the root of this approach is substantial distrust of the possibility of effectively communicating knowledge; the layman (the patient) is not believed to be able to make informed decisions, and the doctor becomes a powerful, distant figure exercising unilateral power on the basis of incommunicable