Truth-telling has been part of one of the great bioethical shifts of the 20th century, from medical paternalism to respect for patient autonomy. Some argue that there are psychiatric cases where truth-telling is less necessary, however. The three standard justifications for medical deception – that the truth can be anti-therapeutic, that patients don't want to know the truth, and that telling the truth is ultimately impossible – seem to be more compelling in psychiatry, and there are additional justifications that apply when psychiatric patients lack the capacity to make their own decisions. Here, I consider those justifications, and argue that truth-telling is paramount even in psychiatry.
Richard AA Kanaan BA MBBS MA MRCPsych is a Clinical Lecturer and Honorary Consultant Psychiatrist at the Institute of Psychiatry/Maudsley Hospital in London, UK. He studied mathematics and philosophy in Oxford and Los Angeles, before training in Medicine and Psychiatry in London. He currently holds a Biomedical Ethics Research Fellowship from the Wellcome Trust. Conflicts of interest: none declared
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