The Truth about Medical Consent

Balancing the need to maintain patients' hope with the imperative of informed consent for medical procedures is a delicate task. Understanding why many doctors struggle with it is the first step toward ensuring that patients' consent truly is informed.

LONDON – Is it acceptable for doctors to withhold information from their patients? Some claim that it is not only acceptable; it is desirable. Hope, they argue, is critical to aid recovery, and a bleak diagnosis should not be allowed to kill it.

In his influential 1803 text Medical Ethics, the English physician Thomas Percival described the doctor’s role as “the minister of hope and comfort to the sick,” noting that at times they should conceal alarming information from their patients. A patient’s life, Percival wrote, can be shortened not only by a doctor’s acts, but also by his words and manner.

The Canadian physician William Osler (whose patients included Walt Whitman) was another fervent believer in the healing power of hope. Indeed, his “unfailing but occasionally unwarranted optimism,” a biographer noted, was one of his most outstanding characteristics. In a 1958 textbook on medical ethics and law, another eminent doctor stated that it is “often clinically wise and in the patient’s interest to withhold certain matters.”