The Grand Inquisitor’s Choice:
Comment on the CEJA Report on
Withholding Information from Patients

Darlyn Pirakitikulr and Harold J. Bursztajn

The Journal of Clinical Ethics 17 (2006): 307-311

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.

To order this article in full, please go to Article Express at the website of the Journal of Clinical Ethics.