Truthful and open communication between physician and patient is essential for trust in the relationship and for respect for autonomy. Withholding pertinent medical information from patients in the belief that disclosure is medically contraindicated creates a conflict between the physician’s obligations to promote patient welfare and to respect patient autonomy.

CME course: Informed consent and decision making

This e-learning module will help physicians identify the standard process of informed consent and how to handle situations when patients cannot give informed consent.

Except in emergency situations in which a patient is incapable of making an informed decision, withholding information without the patient’s knowledge or consent is ethically unacceptable. When information has been withheld in such circumstances, physicians' should convey that information once the emergency situation has been resolved, in keeping with relevant guidelines below.

The obligation to communicate truthfully about the patient’s medical condition does not mean that the physician must communicate information to the patient immediately or all at once. Information may be conveyed over time in keeping with the patient’s preferences and ability to comprehend the information. Physicians should always communicate sensitively and respectfully with patients.

With respect to disclosing or withholding information, physicians should:

  1. Encourage the patient to specify preferences regarding communication of medical information, preferably before the information becomes available.
  2. Honor a patient’s request not to receive certain medical information or to convey the information to a designated surrogate, provided these requests appear to represent the patient’s genuine wishes.
  3. Assess the amount of information the patient is capable of receiving at a given time, and tailor disclosure to meet the patient’s needs and expectations in keeping with the individual’s preferences.
  4. Consult with the patient’s family, the physician’s colleagues, or an ethics committee or other institutional resource for help in assessing the relative benefits and harms associated with delaying disclosure.
  5. Monitor the patient carefully and offer full disclosure when the patient is able to decide whether to receive the information. This should be done according to a definite plan, so that disclosure is not permanently delayed.
  6. Disclose medical errors if they have occurred in the patient’s care, in keeping with ethics guidance.
AMA Principles of Medical Ethics: I, III, V, VIII

Code of Medical Ethics: Informed Consent & Shared Decision Making

Visit the Ethics main page to access additional Opinions, the Principles of Medical Ethics and more information about the Code of Medical Ethics.

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