AMA: Doctors must tell patients the whole story

Shielding patients from bad news undermines the physician-patient relationship, a new policy states.

By Kevin B. O’Reilly — Posted July 10, 2006

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Physicians have an obligation to disclose, sooner or later, all relevant medical information to their patients, says new ethical policy adopted at the AMA's Annual Meeting in June.

The practice known as "therapeutic privilege" that allowed physicians to shield patients from medical information doctors believed would create needless distress or impede healing is no longer acceptable. According to the American Medical Association's new opinion, therapeutic privilege "creates a conflict between the physician's obligations to promote patients' welfare and respect for their autonomy by communicating truthfully."

The opinion gives physicians wiggle room to delay disclosing some medical information if they believe it's contraindicated, but the information should be disclosed over time and "according to a definite plan." The opinion also makes exceptions for emergency situations and after adverse events where liability risk is an issue.

Some physicians raised concerns that the new opinion could conflict with some cultural competency courses that advise physicians to respect differing cultural beliefs about disclosing medical information. "Some family members don't want you to tell a terminally ill family member that they're going to die," said Florida ob-gyn Madelyn E. Butler, MD.

But CEJA Chair Priscilla Ray, MD, said it's practically impossible to shield patients from such information and that, regardless of other beliefs, medicine is always framed by the culture in which it's practiced.

"We practice medicine in a particular culture in the United States, and that is we view the autonomy of patients as paramount," Dr. Ray said.

The new opinion states that if patients ask that they not be informed of certain medical information or that a proxy be told, physicians should honor the request if it appears genuine.

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