When someone is facing serious health challenges, healthcare professionals and family members often struggle to discuss their diagnosis and prognosis. Sharing difficult news, especially about mortality, is never easy. Some may also worry that doing so could lead to despair or even negatively impact the patient’s health.

Ematai endorses the contemporary mainstream medical approach which recommends in most situations not withholding from a patient their true condition.

While every case is different and should be handled individually, sensitively disclosing a diagnosis and prognosis is generally favored for the following reasons: 

1. Practically, it is difficult to hide this information from a patient.  Patients know something is wrong with their body and will ask questions if their treatments change. They may also overhear conversations about their condition that reveal the severity of their illness in an insensitive manner. It’s better for them to hear the truth directly and with compassion rather than being left to make assumptions, which may be worse than the reality.

• Modern healthcare often requires us to make choices in a state of uncertainty.  Questions about treatments like chemotherapy or surgery, for example, require input from the patient, if they are capable, to make informed decisions for themselves.

• Many healthcare experts do not believe that sharing a patient’s prognosis with them can lead to a deterioration in their health.  It is much more important to focus on how sensitively the information is conveyed to them.  Good bedside manners can preserve hope, positivity, and fortitude.  Health care providers should be trained in the art of truth telling in an empathic and compassionate manner.

• Judaism believes that illness offers an opportunity for meaningful conversations, introspection, repentance, and prayer as well as the opportunity to “get affairs in order.” Truth telling allows people to live in the moment and make meaningful choices until their last breath. 

That said, there may be times when it would be harmful to reveal bad news to a sick patient.

• Bad timing: A critically ill patient on their way into surgery may lose hope if informed about the death of a loved one, for example. 
• Inability to understand: Patients with some forms of dementia may not fully comprehend their diagnosis, leading to suffering and confusion.
• Oversharing: Healthcare professionals may also disclose too much information that causes confusion and leads to excessive anxiety while destroying any sense of hope.
• Respecting the right not to know everything:  Patients digest bad news, particularly when it’s a terminal prognosis, in different ways. In some individual cases, a certain amount of unawareness may be helpful on an emotional level. The patient has the right to make that decision. It is inappropriately paternalistic to assert that patients must know everything. The goal of healthcare professionals now is to alleviate suffering, not to douse the denial of death. 

Ultimately, a case-by-case approach is preferred.  Patients beginning an extended treatment process should be asked from the beginning how much they want to be informed and who else they want involved in the treatment and decision making process. The Ematai conversation guide provides space for individuals to record their general preference for receiving information about their diagnosis and prognosis. Their answers should be reviewed as the treatment process progresses and outlooks possibly change.

For further reading, see the linked PDFs in the right margin.

• Judah Goldberg, “Towards a Jewish Bioethic: The Case of Truth-Telling,” Tradition 43:2 (2010)
• Alan Jotkowitz, Shimon Glick, M.D., and B. Gezundheit, “Truth-Telling in a Culturally Diverse World,” Cancer Investigation 24, p. 786–789, 2006.
• Shlomo Brody, “Should we tell the truth to the terminally ill?”, The Jerusalem Post, Dec 9, 2021.