Autonomy has become in many countries a key concept in the patient-physician relationship, leaving the old paternalistic medical attitude out of the realm of common good clinical practice.
Consequently, the validity of the informed consent procedure which is related to any medical intervention, should imply that the information given is true.
Raising the question as such obliges us to consider the truth not for itself but in regard to the validity of the consent to a medical intervention.
Although a clinical approach reveals that loyalty should guide the patient-physician relationship, there are still some situations in which informed consent and truth telling may be controversial: in some circumstances, the physician should or may not tell the truth, in others he can simply forget to tell.
If we use French law as an example, the history of the notion of informed consent has culminated in 2002 with the adoption of the Patient’s Rights Act which has introduced in the Public Health Code a principle that recognizes that “every person has a right to be informed about his/her health”. Therefore, it might seem paradoxical that the physician is still obliged in some circumstances not to tell the truth or is free to decide to not disclose it to the patient.
They are two main cases in which not telling the truth becomes the rule. First, this is when the patient so wishes. Second, it concerns randomised trials.
The existence of a right not to know may appear illogical for two reasons…