Offering truth. One ethical approach to the uninformed cancer patient

A significant minority of cases in which patients are never informed that they have cancer or, although informed of the diagnosis, are not informed when disease progresses toward a terminal phase challenge the understanding of and commitment to an ethical physician-patient relationship.

Abstract

MEDICAL AND social attitudes toward cancer have evolved rapidly during the last 20 years, particularly in North America.1,2Most physicians, most of the time, in most hospitals, accept the ethical proposition that patients are entitled to know their diagnosis. However, there remains in my experience a significant minority of cases in which patients are never informed that they have cancer or, although informed of the diagnosis, are not informed when disease progresses toward a terminal phase. Although concealment of diagnosis can certainly occur in cases of other terminal or even nonterminal serious illnesses, it seems to occur more frequently and in more exacerbated form with cancer because of the traditional and cultural resonances of dread associated with cancer. These cases challenge our understanding of and commitment to an ethical physician-patient relationship. In addition, they are observably a significant source of tension between healthcare providers. When the responsible physician persists