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Medical Ethics

Commentary: Disclosure in Oncology—To Whom Does the Truth Belong?

^aUniversity of North Carolina at Chapel Hill, Lineberger Comprehensive Cancer Center, Division of Hematology and Oncology, Chapel Hill, North Carolina, USA; ^bMemorial Sloan Kettering Cancer Center, New York, New York, USA

Key Words. Clinical ethics • Medical oncology • Personal autonomy • Psychology

Correspondence: William A. Wood, M.D., M.P.H., University of North Carolina at Chapel Hill, Lineberger Comprehensive Cancer Center, Division of Hematology and Oncology; Campus Box 7305, 3rd Floor, Physicians' Office Building, 170 Manning Drive, Chapel Hill, North Carolina 27599-7305, USA. Telephone: 919-843-7717; Fax: 919-966-6735; e-mail: wwood{at}unch.unc.edu

Received July 24, 2008; accepted for publication December 9, 2008; first published online in THE ONCOLOGIST Express on January 15, 2009.

Disclosures

William A. Wood: None; Mary S. McCabe: Consultant/advisory role: Lance Armstrong Foundation; Research funding/contracted research: Lance Armstrong Foundation; Richard M. Goldberg: Consultant/advisory role: American Society of Clinical Oncology, Cancer and Leukemia Group B

Section editor Rebecca D. Pentz has disclosed no financial relationships relevant to the content of this article.

The content of this article has been reviewed by independent peer reviewers to ensure that it is balanced, objective, and free from commercial bias.

Target audience: Physicians who wish to advance their current knowledge of clinical cancer medicine in risk management.

The term "therapeutic nondisclosure" refers to a clinician's decision to withhold diagnostic or prognostic information from a patient to protect him or her from perceived harm. We present a vignette in which the son of a 75-year-old Italian born immigrant asks her physician to withhold her new diagnosis of advanced myeloma. In the U.S., trends over the last 30 years have been toward more complete disclosure of cancer-related information. This can be attributed to the evolution of research subject protections, the "war on cancer," the civil rights and patient rights movements, and the rise of hospice and palliative care. In other parts of the world, however, therapeutic nondisclosure is still commonly practiced. Here, we deconstruct and call into question current arguments for nondisclosure. We provide practical recommendations to the practicing clinician in the U.S. who wishes to approach a request for nondisclosure, and disclosure itself, in a compassionate and respectful way.