The patients' right-to-know debate

The Czech Senate recently approved a law giving patients the right to know their state of health, adopting a charter drawn up by the United Nations. In this week's programme, Nick Carey examines the fierce debate among doctors and the general public surrounding this issue.

In early May, the Czech Senate approved the United Nation's charter on the right of patients to be fully informed about their health. This means that if a patient is diagnosed as having cancer, their doctor is obliged to tell them - if they so desire - exactly what is wrong with them, why they are undergoing specific treatment, and what their chances of survival are. But although the treaty was approved, the vote in the Senate was preceded by a fierce debate. For although in many countries in Western Europe a patient's 'right to know' is taken for granted, for decades the Czechs were not told the whole truth, and sometimes nothing at all. Some doctors say this must change, while the treaty's opponents say the Czechs are not ready for the truth.

Senator Jaroslava Moserova, herself a doctor, is one of those who strongly backed the treaty. She says a patient's 'right to know' is a basic human right: Doctor Pavel Bocek agrees. He believes if patients know exactly what they are suffering from, they are more co-operative in fighting their illness: But Senator Premysl Sobotka, also a doctor, opposed the approval of the treaty. He says Czechs are just not ready for it:

"The patient has to be prepared to hear the whole truth for this to work, and Czech patients are not. The truth is that this is not the United States, people are not used to hearing what is wrong with them, and if we tell them the whole truth in one go, we'll do more harm than good."

The practice of not informing patients about their state of health goes back a long way. Some doctors say the system is a remnant of the Communist regime, others say it predates even that. Senator Moserova says the practice began because doctors wanted to protect their patients. But now, she feels this has created taboos out of diseases such as cancer: The past ten years have brought many changes to the medical profession in the Czech Republic. According to Professor Jaroslav Blahos, head of the World Medical Association, the difference between the system here and the West is still palpable, but the Czechs are getting closer to the Western model:

And this is the main crux of the argument, whether or not Czech patients are ready to hear the truth after decades of being given rudimentary information about the state of their health. According to many of those in the camp who oppose the introduction of the treaty, like Senator Sobotka, the whole truth now would be too much too soon for Czechs:

"This treaty says that we must fully inform patients, but sometimes the truth of the disease they have is too harsh. If we told them everything, then they could become too negative and succumb to their disease much more quickly. We are not ready, and we need more time to prepare Czechs for the truth."

But Doctor Pavel Bocek strongly opposes this approach. He says no matter how unprepared the system is, Czech patients must know the truth: Another argument against the introduction of the treaty is that some patients may not want to know what is wrong with them. Research has shown that the majority of Czechs do want to know what is wrong with them, but there are indeed those who would rather not know anything other than that which is absolutely necessary. According to Senator Moserova, the treaty acknowledges this, and patients are not forced to know anything: Professor Blahos believes that what the issue boils down to is communicating with patients, and that in certain cases where patients might be adversely affected by finding out the truth, then doctors must proceed with caution: Not telling the full truth to patients has, says Senator Moserova, led the Czechs to distrust doctors, and even to jump to unpleasant conclusions when their lives are not in danger: But the debate over the right of patients to obtain information on their state of health is, it seems, largely confined to doctors of older generations, or those who obtained their qualifications during the Communist regime, or just after it. The current generation of Czech physicians is apparently unaware that this should be an issue: For Doctor Pavel Bocek, the issue at hand is more than just telling patients the truth. It involves breaking the taboo about diseases such as cancer, and creating public awareness inside and outside the doctor's surgery: And for Senator Moserova, all Czech doctors of the older generation need to do is to learn to help patients through the shock of their disease and to work with them to fight it: