Full information is one of the legal pillars of informed consent, the other being free and unforced consent itself.13 There are exceptions to such disclosure, including “therapeutic privilege,” which allows the physician not to disclose information to the patient or to obtain the consent of an appropriate surrogate if disclosure of the information would be so harmful that the result would be countertherapeutic and would cause prejudice. 21 There is often concern about harming the patient, especially by physicians in areas where incurable diseases are common, about the “inhumanity” of telling the patient the unvarnished truth.29 However, it is important to distinguish between the inherently undesirable nature of bad medical news and information that could actually have negative physical consequences for the patient, to be distinguished. The majority of patients surveyed want information, even if they predict their imminent demise.30 In fact, the actual need for therapeutic privilege is rare when used for one`s intention rather than giving the physician the opportunity to avoid a difficult conversation. While it is appropriate to convey information in a sensitive manner, it should nevertheless be transmitted. Another duty that the physician has to patients and family is truthfulness or truthfulness. This duty concerns the patient`s right to autonomy, as it is not possible to exercise this right if the patient does not have a clear idea of the current situation, future prognosis and available options. However, one can imagine situations where this duty seems to conflict with other duties or responsibilities. For example, in situations where certain information is considered potentially dangerous to a patient, some physicians have invoked “therapeutic privilege” in withholding that information. However, the courts have viewed this practice with dissatisfaction (Thornburgh v. American College of Obstetricians, 1986), and recent revisions to the American Medical Association`s Code of Professional Conduct have found the practice “ethically unacceptable” (American Medical Association, 2010-2011). Other difficult situations include potential pressures to withhold or modify information provided to a third party, such as an insurance company, in order to obtain necessary services from a patient (Morreim, 1991). While the pressure is real and the motivations for considering such an approach may be noble, there is no ethical justification for lying. “Therapeutic privilege,” a doctor`s decision to hide information from a patient for his or her own good, is a concept of the past, the American Medical Association (AMA) noted.
Q68.9 Box 68.2 lists four recognized exceptions to the usual informed consent requirements. (1) An important exception is emergency treatment, where the patient`s condition presents a risk of death or severe disability if treatment is not administered immediately, if the patient is currently unable to make and express an autonomous decision, and if no appropriate surrogate mother is available.