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Therapeutic privilege: between the ethics of lying and the practice of truth
  1. Claude Richard1,
  2. Yvette Lajeunesse2,3,
  3. Marie-Thérèse Lussier1,2
  1. 1Primary Care Research Team, Centre de santé et de services sociaux de Laval, Hôpital Cité-de-la-Santé, Laval, Québec, Canada
  2. 2Department of Family Medicine and of Emergency Medicine, Faculty of Medicine, University of Montreal, Québec, Canada
  3. 3Département de Médecine Générale, Institut universitaire de gériatrie de Montréal, Québec, Canada
  1. Correspondence to Dr Claude Richard, Primary Care Research Team, Centre de santé et de services sociaux de Laval, Hôpital Cité-de-la-Santé, 1755 René-Laennec Blvd., Laval, Québec, Canada H7M 3L9; ell4400{at}videotron.ca

Abstract

The ‘right to the truth’ involves disclosing all the pertinent facts to a patient so that an informed decision can be made. However, this concept of a ‘right to the truth’ entails certain ambiguities, especially since it is difficult to apply the concept in medical practice based mainly on current evidence-based data that are probabilistic in nature. Furthermore, in some situations, the doctor is confronted with a moral dilemma, caught between the necessity to inform the patient (principle of autonomy) and the desire to ensure the patient's well-being by minimising suffering (principle of beneficence). To comply with the principle of beneficence as well as the principle of non-maleficence ‘to do no harm’, the doctor may then feel obliged to turn to ‘therapeutic privilege’, using lies or deception to preserve the patient's hope, and psychological and moral integrity, as well as his self-image and dignity. There is no easy answer to such a moral dilemma. This article will propose a process that can fit into reflective practice, allowing the doctor to decide if the use of therapeutic privilege is justified when he is faced with these kinds of conflicting circumstances. We will present the conflict arising in practice in the context of the various theoretical orientations in ethics, and then we will suggest an approach for a ‘practice of truth’. Last, we will situate this reflective method in the broader clinical context of medical practice viewed as a dialogic process.

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Footnotes

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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