[To tell or not to tell the truth to cancer patients?].

The physician-patient relationship is a significant component of the treatment strategy. Communication constitutes perhaps the most important process in medicine. Among various aspects of the direct relationship between the physician and the patient, conversations with the patient are among the most important. It is the duty of the physician to supply the patients with explanations. However, cooperation between the physician and the patient is not merely a question of mutual goodwill and readiness. It also depends on certain other factors, the nature of which may be associated with, for instance, knowledge and competence, i.e., the professional training of the physician for his work with patients. It is increasingly evident that medical knowledge must be supplemented by basic knowledge of psychology, so that the physician may make fuller use of the therapeutic power of words to enlist the patient’s psychological reserves. One of the most popular and idealistic forms of the physician-patient relationship in modern society assumes that a good doctor takes care of patients with very serious diseases and provides treatments that lead for a cure. Such an idealistic model rarely happens in reality. Eliot Freidson pointed out that there is a conflict of interest, expectations and knowledge between medical professionals and patients. Patients prefer doctors who they can trust and also receive answers to their questions in a professional manner. It seems that this last aspect is crucial for patient engagement in the treatment process. The physician-cancer patient relationship constitutes a most complex problem, and one of the most difficult aspects of this problem is sincere communication with the patient. Despite the passage of time this matter remains one of the most controversial questions. Among the main dilemmas is whether the patient should be told the truth. Most American physicians are willing to inform the patient who, they assume, has the right to learn the truth and decide whether the family should also be informed. Physicians in Europe, including Poland, are more in favor of telling the family first. Both approaches raise many doubts, uncertainties, and moral dilemmas. Should the cancer patient be told the whole truth even when the disease is advanced and there is no chance of a cure? Or should the patient be cheated, should the seriousness of the situation be minimized by explanations that there is still hope, that within days the patient’s health is going to improve, while telling the whole truth to the family? Is such an attitude an expression of cowardice, mercy, conformity or pity? Is withholding the truth about the state of his or her condition from the patient a lie, a choice of a lesser evil or an act of grace? How can we separate truth and honesty with respect to the patient, who trusts us and listens with hope to our every word? According to what