Ethics of witholding information

It turns out to be sur­pris­ing­ly com­mon. Accord­ing to the Octo­ber Harper’s index bq. Per­cent­age of U.S. doc­tors who say they have not told patients about a treat­ment because their insur­ance did­n’t cov­er it : 31 In major pub­lic hos­pi­tals, the pro­vi­sion of expen­sive med­ical treat­ment to pub­lic patients drains fixed bud­gets. In some cas­es, the hos­pi­tal must restrict access to these treat­ments. The resource allo­ca­tion prob­lem presents many eth­i­cal chal­lenges. But should pub­lic patients be informed of treat­ment options that are not avail­able on the pub­lic charge and that, in the view of the doc­tor, they can­not afford? Many peo­ple are inclined to say that there are cir­cum­stances where it is a kind­ness to pro­tect igno­rance: to ‘pro­tect’ a patient from a deci­sion whether, for exam­ple, to mort­gage their house or sell their car in order to pay for an expen­sive treat­ment. They argue that with­hold­ing infor­ma­tion is a part of the duty of a doc­tor act­ing ‘in the role of a par­ent’ at a time when the patient is under stress due to ill­ness or hos­pi­tal­iza­tion and may have reduced capac­i­ty for deci­sion-mak­ing due to stress, anx­i­ety or drugs. But is it ever eth­i­cal to deny a con­scious, basi­cal­ly com­pe­tent adult—whatever their state of mind—full auton­o­my of choice? When we say a per­son ‘can­not afford’ a treat­ment, we might mean that they do not have the resoures in any case to pay for the treat­ment: the funds are sim­ply not avail­able. But some­times we mean that they val­ue oth­er things more and choose, for exam­ple, to keep the car rather than the more expen­sive pros­the­sis. This is a choice about pref­er­ences. When, if ever, is a med­ical prac­ti­tion­er jus­ti­fied in mak­ing a pref­er­ence deci­sion for a com­pe­tent adult?

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