Consent Embodies the Idea That as a

¶ … consent embodies the idea that as a matter of ethics and law patients are entitled to be exposed to all of the relevant information that would influence and guide their decision making concerning what treatment that they should follow.

However, should clinicians provide medical information to terminally ill patients when they suspect that such information could potentially be used to facilitate their suicide? The issues surrounding full disclosure, beneficence, and therapeutic privilege as they relate to patients and their families are discussed and recommendations regarding how such cases should be conceptualized are discussed. Should clinicians provide medical information to terminally ill patients when they know or suspect that such information will be used to facilitate their suicide? This dilemma affects patients, their families, physicians, other medical professionals.

The notion of "informed consent" as a guiding principle in medicine is at the center of modern professional medical ethics. Informed consent embodies the idea that as a matter of proper ethics and law patients are entitled to be exposed to all of the relevant information that would influence and guide their decision making concerning what treatment, if any, they should follow.

If a patient does not have the capacity to make medical decisions themselves then a substitute decision-maker (previously assigned by the patient or by the court) should be provided with such information. Even though the ideals of full disclosure and informed consent are often referred as fundamental directives in many other professional fields, the notions of full disclosure and informed consent evolved within the context of American medicine. These directives have traditionally been emphasized as the result of a moral concern with the basic human and constitutional right to self-determination.

There is a long history of this basic right being upheld in the court system and therefore as a matter of both proper ethical behavior and law physicians have a duty to disclose information about the patient's diagnoses, prognosis, and the risks and benefits of any proposed treatments (Paterick, Carson, Allen, & Paterick, 2008). When these disclosures are made the ethical principle of "beneficence" should be applied. Beneficence states that physicians should reveal information in a manner that is beneficial and not harmful to patients (Shatz, 1986).

The ethical principle of beneficence has led to the notion of therapeutic privilege, an exception to the need to provide full disclosure.

Therapeutic privilege allows a physician to withhold information from a patient or surrogate decision maker out of the concern that full disclosure could either be psychologically harmful to the patient and thus jeopardize the patient's physical health or when a full explanation of a procedure might lead to the patient to forego a treatment or operation that the physician believes is in the patient's best interest or is the sole option. In addition, family members will occasionally ask physicians to withhold information from patients.

Such requests from family members are most often performed out of feelings of wanting to protect the patient as the family may believe that full disclosure will be more harmful than beneficial. These types of requests can often be difficult to honor because hiding a diagnosis from a patient can be difficult especially if treatment is needed because patients can figure out that they are seriously ill by the type of treatment they are exposed to.

In any event, in order to withhold information from patients there must be a justifiable reason, especially when the patient is capable of making medical decisions. For specific instances and ethical review there is a rich history and justification for full disclosure that is well documented including legal and ethical debates for and against it (Paterick, Carson, Allen, & Paterick, 2008; Tan, Teo, Wong, & Lim, 1993). Of course these particular cases, citations, and reviews would prove indispensible in determining the merits of any particular case.

In addition, there is a parallel literature regarding disclosure and informed consent in scientific research that has practical applications to the issue of withholding disclosure of information to patients (World Medical Association, 1997). Past surveys have indicated that as many as 50% of terminally-ill patients had not been informed of the diagnosis (Russell & Ward, 2011; Yun, Kwon, Lee, Lee et al., 2010). However, Young et al.

(2011) in a study that included nearly 500 cancer patients and 400 caregivers found that patients prefer to be notified fully and their quality of life and treatment is generally better if they are notified. An earlier study by Tan, Teo, Long and Lim (1993) indicated that almost 84.0% of physicians will agree to the family's request not to disclose diagnostic information to the patient.

Despite a large body of ethical standards and numerous legal precedents in favor of disclosure there is an indication that disclosure in life-threatening illnesses such as cancer was often the exception rather than the rule. Therefore it is apparent that in practice there is a significant proportion of cases that do not receive full disclosure, even in cases where there may be no reason to withhold information.

When faced with this decision or when evaluating specific cases ethical review boards need to consider the past literature, legal cases, current reasons for non-disclosure and how these reasons have been historically addressed both legally and ethically, and any other factors relevant to the current situation that can be applied to both ethical guidelines and legal precedent. It is a fundamental right of the.