Informed Consent and Disclosure for Terminally Ill Patients
This paper examines the ethical dilemma clinicians face when deciding whether to provide full medical disclosure to terminally ill patients who may use that information to facilitate suicide. It discusses the foundational principles of informed consent and beneficence as they have evolved in American medicine, explores the legal and ethical basis for full disclosure, and analyzes the concept of therapeutic privilege as a justifiable exception. Drawing on empirical studies showing that up to 50% of terminally ill patients have not been informed of their diagnoses, and on legal precedents supporting the right to self-determination, the paper recommends that such cases be evaluated individually by ethics review boards, balancing the patient's fundamental right to information against potential harm.
- Introduction: Central dilemma of disclosure to terminally ill patients
- Informed Consent and the Right to Self-Determination: Legal and ethical basis for full patient disclosure
- Beneficence and Therapeutic Privilege: When withholding information may be justified
- Family Requests and the Challenges of Withholding Information: Complications when families request non-disclosure
- Empirical Evidence on Disclosure Practices: Survey data on actual terminal diagnosis disclosure rates
- Ethical Review and Recommendations: Case-by-case ethics board review recommended
✍️ How to write this paper — guide, tools & examples ▾
What makes this paper effective
- The paper frames a narrow, high-stakes clinical dilemma clearly at the outset, making the ethical tension between disclosure and potential harm immediately apparent.
- It integrates legal precedent, philosophical principles (beneficence, autonomy), and empirical survey data, giving the argument a multi-layered foundation that is stronger than any single source alone.
- The paper acknowledges competing perspectives — including family requests for non-disclosure and the reality of clinical practice — rather than presenting a one-sided argument, which strengthens its credibility.
Key academic technique demonstrated
The paper demonstrates effective use of ethical principle analysis alongside empirical evidence. Rather than relying solely on abstract moral reasoning, it grounds claims in cited studies (e.g., Young et al., 2011; Tan et al., 1993) and references legal history, showing how to build an applied ethics argument that is both philosophically coherent and empirically supported.
Structure breakdown
The paper opens by posing the central clinical-ethical question, then systematically introduces and defines the governing principles: informed consent, beneficence, and therapeutic privilege. It next examines practical complications — including family-requested non-disclosure — before presenting survey data on actual disclosure rates. It concludes with a policy-oriented recommendation that ethics review boards evaluate cases individually, tying the empirical and theoretical threads together.
Introduction
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, and other medical professionals alike. Informed 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 — if any — they should follow. The issues surrounding full disclosure, beneficence, and therapeutic privilege as they relate to patients and their families are discussed herein, along with recommendations regarding how such cases should be conceptualized.
Informed Consent and the Right to Self-Determination
The notion of informed consent as a guiding principle in medicine is at the center of modern professional medical ethics. 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 referenced as fundamental directives in many other professional fields, these notions evolved within the context of American medicine. They 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 diagnosis, 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).
Beneficence and Therapeutic Privilege
The ethical principle of beneficence has led to the notion of therapeutic privilege, an exception to the requirement of full disclosure. Therapeutic privilege allows a physician to withhold information from a patient or surrogate decision-maker out of concern that full disclosure could either be psychologically harmful to the patient — thereby jeopardizing the patient's physical health — or that a full explanation of a procedure might lead the patient to forgo a treatment or operation that the physician believes is in the patient's best interest or is the sole viable option.
In addition, family members will occasionally ask physicians to withhold information from patients. Such requests are most often made out of a desire to protect the patient, as the family may believe that full disclosure will be more harmful than beneficial.
References
Monagle, J. F. (1998). Health care ethics: Critical issues for the 21st century. Gaithersburg, MD: Aspen Publications.
Paterick, T. J., Carson, G. V., Allen, M. C., & Paterick, T. E. (2008). Medical informed consent: General considerations for physicians. Mayo Clinic Proceedings, 83(3), 313–319.
Russell, B. J., & Ward, A. M. (2011). Deciding what information is necessary: Do patients with advanced cancer want to know all the details? Cancer Management and Research, 23, 191–199.
Shatz, D. (1986). Autonomy, beneficence and informed consent: Rethinking the connections. Cancer Investigation, 4, 257–269.
Tan, T. K. S., Teo, F. C. P., Wong, K., & Lim, H. L. (1993). Cancer: To tell or not to tell? Singapore Medical Journal, 34, 202–203.
World Medical Association. (1997). Declaration of Helsinki: Recommendations guiding physicians in biomedical research involving human subjects. Reprinted in Journal of the American Medical Association, 277, 925–926.
Yun, Y. H., Kwon, Y. C., Lee, M. K., Lee, W. J., Jung, K. H., Do, Y. R., Kim, S., Heo, D. S., Choi, J. S., & Park, S. Y. (2010). Experiences and attitudes of patients with terminal cancer and their family caregivers toward the disclosure of terminal illness. Journal of Clinical Oncology, 28(11), 1950–1957.
Create your account
Always verify citation format against your institution’s current style guide requirements.