The Grand Inquisitor’s Choice:
Comment on the CEJA Report on
Withholding Information from Patients
Darlyn Pirakitikulr and Harold J. Bursztajn
Historically, paternalism had been the accepted norm in doctor-patient
relationships. By virtue of their knowledge and experience, doctors
decided what treatment was in the best interests of patients. However,
in recent years, medicine has changed from a predominantly paternalistic
profession to one that is more patient- centered. The physician informs
and advises the patient, but it is the patient who makes the decision.
Given this evolution, the physician’s dual duties of promoting the
patient’s health while supporting the patient’s autonomy, by providing
pertinent medical information, can at times become a balancing act.
The physician must weigh, on the one hand, the value of the patient’s
liberty to make personal medical choices based on full disclosure
of relevant information, and, on the other, the patient’s health,
which in rare instances might be compromised by full disclosure.
. . .
Ultimately, therapeutic privilege is all-too often a misnomer. Withholding
information is not a privilege, as it burdens the doctor-patient
alliance. If the term “therapeutic privilege” has any meaning, it
is only because it is exercised after carefully listening to the
patient. The doctor- poet William Carlos Williams spoke of “the poem
which their [patients’] lives are being lived to realize.” Mechanical
adherence to prosaic guidelines is no substitute for caring and for
listening to the poem of our patients’ lives.
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