What you don't know, can HELP you?
Like cave divers, we journey into the murky realm of therapeutic privilege.
Bing AI image creator, again.
Is it ever okay for a medical provider to lie to a patient for their own good? Of course not! You say. Why even ask such a question? Well let me ask another one: “It is ever okay for a medical provider to withhold information from a patient for their own good?” Some of you are now questioning my sanity. Didn’t we just say you can’t lie? That’s because many people equate lying with withholding information. But is that true. To make the distinction is to dive into the murky depths of what’s called therapuetic privilege.
“Privilege” is definitely a problematic word these days and this is no less so for “therapeutic privilege.”(Hereafter TP) The American Medical Association has a uneasy and cautious relationship with the concept. Here’s the statement in a nutshell
“Physicians may withhold information from the patient about diagnosis and/or treatment when disclosing it would cause a serious psychological threat that makes it medically contraindicated.”
The AMA code of ethics considers TP an exception to informed consent guidelines, and when discussed it is with a lot of tiptoeing and darn near tapdancing around the issue. To put it bluntly, the AMA doesn’t want to completely rule out TP but they make it clear that TP should be used only in very, very specific circumstances and then sparingly.
Practical Bioethics summarizes these narrow constraints into four conditions:
1. The information should be withheld, not altered as if lying to the patient.
The information must not be information that a patient would need to make a medical decision.
The information must be withheld for the patient’s benefit, not in order to avoid negative patient interaction.
The information must be withheld only temporarily.
Most of these conditions are the result of Appeals Court case called Canterbury v. Spence. Jerry Canterbury needed surgery for ruptured disc in his back. Dr. Spence informed him that surgery was his best option but admitted later that he left out a serious but rare risk of paralysis in 1% of patients because he thought it would disuade Canterbury from consenting to surgery. You guessed it, Canterbury experienced this rare side-effect. An Appeals court ruling said Spence should have disclosed this information because any reasonable person might need this info to make a medical decision.
Jerry Canterbury worked for the FBI as a clerk. Here he poses with a portrait of J. Edgar Hoover.
In Practical Bioethics, I list four paradigm cases to test your intuitions about these four conditions. Here are three for you to consider:
A primary-care physician knows that a patient suffers from severe anxiety and intrusive thoughts for which he has never received treatment. She needs to send the patient to an oncologist to have a biopsy to rule out cancer. The appointment is two weeks away, and she is concerned that if she tells the patient where she is sending him, he will suffer severe anxiety worrying about the upcoming biopsy. The physician tells him she’s sending him to a “liver specialist” for a biopsy, knowing that as soon as the patient arrives, he will realize it is an oncologist.
A patient has an inoperable brain tumor and the neurologist is concerned about how the patient will take the news since there is no treatment indicated. The neurologist tells the patient that they have an incurable brain disorder and prescribes some medication to help with the symptoms. The patient dies in a few weeks.
A patient is admitted to ER after taking an overdose of pain medication in a suicide attempt. He ends up in the ICU due to complications. Routine test results indicate that the patient may have pre-cancerous tumors in his stomach. The ICU staff do not tell him the results while he is in their care. He is informed of the results when he is moved to a regular room.
It’s important to note that some medical providers forgo what they consider moral hair-splitting in favor of a policy of never withholding information from a patient. I can’t comment since, as a moral philosopher, hair-splitting is what I do all the time.