PHLB09H3 Chap.2 Truth Telling, Therapeutic Privilege and Privacy
Truth Telling, Therapeutic Privilege and Privacy
A history that sets the default
The week opens with Sisk and colleagues' history of truth telling in American medicine. For most of that history physicians withheld bad news, especially cancer diagnoses, believing that discouraging words harmed patients. A survey in 1961 found most physicians preferred not to disclose a cancer diagnosis; by 1979 the same questions found the opposite.
Disclosure is now the expected standard, and the authors call the story unfinished because how and how much to tell are still debated.
The narrow exception
Wynia's short case discussion defines therapeutic privilege as an exemption from informed consent rules and treats it as plainly paternalistic. On the standard view he reports, it applies only when disclosure would itself be a serious psychological threat.
It cannot be used to obtain consent to treatment, to avoid delivering bad news, or on grounds of beneficence alone.
Confidentiality and its limits
The CMA Code makes confidentiality a duty, with sharing limited to what benefits the patient within the circle of care. Disclosure beyond that requires consent or must be as provided for by law.
This is where the oral question on the duty to warn and on why privacy matters ethically belongs.
What this chapter covers
- 01
Benevolent Deception
- 02
Shift to Disclosure
- 03
Therapeutic Privilege
- 04
Standard View Conditions
- 05
Circle of Care
- 06
Duty to Warn
- 07
Why Privacy Matters
Worked example · free
Apply the standard view to a request to delay bad news
- 2State the standard view's condition for invoking the privilege.
- 2Apply it to this patient's capacity and to the reason offered.
- 2Explain why the line protects competent patients and trust.
Key terms
- Benevolent Deception
- Benevolent deception is withholding or shading the truth out of concern for a patient's well-being, the norm Sisk and colleagues describe before the shift to disclosure.
- Duty to Warn
- The duty to warn is a legally recognised limit on confidentiality that can require disclosure when a patient poses a serious threat to another person.
- Iatrogenic Suffering
- Iatrogenic suffering is distress caused not by a disease but by the way the health system treats the patient, a risk Wynia raises in his case.
Truth Telling, Therapeutic Privilege and Privacy FAQ
What is therapeutic privilege?
It is a narrow exception to ordinary informed consent requirements. On the standard view Wynia reports, a physician may withhold information about diagnosis or treatment only when disclosing it would pose a psychological threat so serious that it is medically contraindicated. It is not a way to secure agreement to treatment or to avoid giving bad news.
Why is the line for withholding drawn so narrowly?
Competent patients keep the right to accept or refuse treatment, and they need information to use that right. Allowing withholding whenever a physician thinks it helps would let beneficence override autonomy and would invite hiding risks that might lead a patient to refuse. Deception discovered later also damages the trust on which future care depends.
Why does privacy matter in medicine?
Patients disclose sensitive facts because they trust that the information will be protected; without that trust they may hide what clinicians need to know. Privacy also preserves patients' control over their own health information and expresses respect for their dignity, which is why the CMA Code warns against conversations that could reveal identifying details.
What changed physicians' attitudes to disclosure?
Sisk and colleagues point to several pressures in the 1960s and 1970s: research scandals such as Tuskegee, civil rights and consumer movements that challenged authority, informed consent law, hospice care and patient rights documents. By 1979 a large majority of surveyed physicians favoured disclosing cancer diagnoses, reversing the result of the same survey taken in 1961.
Exam move
Write the standard view of therapeutic privilege as a two-line rule, then list three reasons that are not enough to invoke it. Draw the confidentiality route from memory, marking where consent and law enter, and practise placing the duty to warn on it. Prepare a three-reason answer to why privacy matters and decide which reason you would defend first.
Finally, rehearse the one-minute opening aloud and time it, cutting any sentence that is not needed to answer the question.
