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Evidence Library · What you are owed

Sparing your feelings is not a reason to keep you in the dark

There is a name for withholding information to protect a patient. ACOG calls it ethically unacceptable, and gives three reasons.

Doctors sometimes hold something back because they think a patient has enough to cope with. It is usually kindly meant. It has a formal name, and ACOG has ruled on it.

ACOG's full statement, quoted whole because half of it would misrepresent the position:

Therapeutic privilege refers to a physician's withholding of medical information from a patient because of concern that it may cause psychological or emotional harm to the patient. The concept of therapeutic privilege has been misinterpreted in the past to be an exception to the ethical requirement of providing adequate, accurate, and comprehensible information to a patient with decision-making capacity. Invoking therapeutic privilege is ethically unacceptable because it suggests that physicians always know what is best for their patients, requires a physician to predict the future, and opens the door for coercive misuse under the guise of the patient's best interest. The American College of Obstetricians and Gynecologists and the American Medical Association assert that although it is never ethically acceptable to withhold information without the patient's knowledge and consent, it is acceptable to communicate information over time based on the patient's stated preferences and ability to understand the information.

Three reasons, and the third is the sharp one: it opens the door for coercive misuse under the guise of the patient's best interest. Once it is acceptable to hide something for your own good, someone will eventually hide something for theirs.

The part people leave outThe last sentence matters as much as the rest. ACOG does allow information to be given over time, at a pace you set. What it forbids is withholding without your knowledge and consent. The line is between pacing at your request and deciding for you that you should not know. If you want everything at once, say so, and that ends the discussion.
Say this out loud"Please give me all of it, including the parts you think might upset me."

"Is there anything about my situation you have decided not to tell me?"

"I would rather hear this in one go than in pieces."
Where this comes from:
419. Informed consent and shared decision making in obstetrics and gynecology. ACOG Committee Opinion No. 819. American College of Obstetricians and Gynecologists. Obstet Gynecol. 2021;137(2):e34-e41.

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This page is educational. It supports the conversation with your own clinicians. It is not consent to any treatment, and it cannot assess you. If you are worried about a symptom now, see urgent warning signs.