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Truth telling, autonomy and the role of metaphor
  1. D Kirklin
  1. Correspondence to:
 D Kirklin
 Department of Primary Care and Population Sciences, Royal Free and University College Medical School, Archway Campus, 2nd Floor, Holborn Union Building, 2-10 Highgate Hill, London N19 5LW, UK; d.kirklin{at}


This paper examines the potential role of metaphors in helping healthcare professionals to communicate honestly with patients and in helping patients gain a richer and more nuanced understanding of what is being explained. One of the ways in which doctors and nurses may intentionally, or unintentionally, avoid telling the truth to patients is either by using metaphors that obscure the truth or by failing to deploy appropriately powerful and revealing metaphors in their discussions. This failure to tell the truth may partly account for the observation by clinicians that patients sometimes make decisions that, from the perspective of their clinician, and given all that the clinician knows, seem unwise. For example, patients with advanced cancer may choose to undergo further, aggressive, treatment despite the fact that they are likely to accrue little or no benefit as a result. While acknowledging that the immediate task of telling patients the truth can be difficult for all those concerned, I argue that the long-term consequences of denying patients autonomy at the end of life can be harmful to patients and can leave doctors and nurses distressed and confused.

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  • i In this paper, the authors describe a case in which a mother was covertly giving the drug to her son, who had schizophrenia, in his soup. The authors ask whether the doctor should continue to prescribe the drug, thus becoming complicit in by-passing the patient’s autonomy.

  • ii This supplement was devoted to edited transcripts from the Swartz Rounds, and commentaries about the process, content and outcomes from these healthcare professional-centred oncology rounds.

  • Competing interests: None.

  • Funding: None.

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