How Much Would You NOT Want to Know?

In theory, if patient autonomy principle is to be strictly followed then not only should informed consent be made available for the patient but also, if the patient desires, "uninformed consent". The question arises shouldn't as part of true autonomous decision-making by a patient, the patient should be given the respect not to be told matters that the patient rejects being told about? If this feature of true autonomy is to be followed there can arise complex ethical and legal issues for the physician. At this time, the standards and legal aspects of medical practice fail to account for this possibility. The physician considering complying with the patient's request will be treading in uncharted professional waters with the possibilities of malpractice and licensure reprocussions to be considered. If you were the physician, would you, for example, perform elective surgery or administer chemotherapy without telling the patient the diagnosis, reason for the therapy and the risks and benefits associated with the procedure?

Some patients for various reasons wish not to be told. Within some cultures, it is established norms that patients are not to be told "bad news" for various reasons but often because it is felt that the telling will lead to physical and emotional injury to the patient and contribute to the failing of the patient's medical condition. Family members or members of the community declare that they have become ad hoc surrogates to the patient and expect to be told the medical details and to make the medical decisions instead of the patient. If this view is in direct opposition to the norms of medical practice in the country where the patient is being treated, such as in America, what is the physician to do? A dilemma is faced. Should the physician follow the standards of practice in his/her country but perhaps fail to be beneficent towards the patient? Physicians may decide that they will bypass the cultural norms and go directly to the patient and have the patient tell the physician how much and what the patient doesn't want to know. But how does the physician set the question to the patient without premature and unwanted revelation?

Write me comments about what you would do if you, as a physician, faced this issue. ..Maurice.