Author’s Note: These questions will be explored further in a panel discussion at the 2026 CMDA National Convention in Loveland, Colorado on April 24, featuring Dr. John Francis and Dr. Janet Liljestrand.

Is it ethically acceptable to lie to one’s patients? Most of us would respond with an immediate, emphatic, “No!” Like numerous seemingly simple questions, answers are often complex. This blog post deals primarily with informed consent and disclosure of unexpected outcomes and medical errors. There is a big difference between lying and choosing not to immediately say every thought you have when you don’t have all the facts. The first is wrong, and the second option is often best.

Merriam Webster defines lying as “saying or writing something that is not true in order to deceive someone.”  In this article, the “author outlines 12 common types of lies, including bold-faced lies, broken promises, lies of fabrication, lies of deception, exaggeration, plagiarism, denial, omission, minimization, withholding information, and selective memory. It notes that classifications of lies can vary depending on the source, and some lies may fall under multiple categories.”

A shorter list might include pretending we are someone we aren’t, withholding information, burying the lead—emphasizing extraneous points before mentioning the truth in passing, minimizing, diverting, exaggerating and blatant lies.

Motivations for lying may include covering one’s tracks to avoid blame or punishment, making oneself look good or others look bad, garnering sympathy or advantage or seeking to protect oneself from legal recourse. Acknowledging these definitions and incentives for lying, most of us would nonetheless remain opposed to any deception in healthcare professional-patient communications, but interestingly, philosophers and physicians have not always supported full disclosure.

Ethical healthcare professionals often quote portions of the Hippocratic Oath and related writings, perhaps most notably, “First, do no harm.”  This statement is not in the oath, per se, but is part of the Hippocratic writings. Another quote from the writings is, “Perform your medical duties calmly and adroitly, concealing most things from the patient while you are attending to him….” So, we see that Hippocrates himself might condone and even encourage a lesser degree of transparency than we ascribe to today.

In an 1871 graduation speech, Oliver Wendell Holmes, MD (not the jurist, his son), said, “Your patient has no more right to all the truth you know than he has to all the medicine in your saddlebag…he should only get just so much as is good for him.” Holmes was ahead of his time in numerous ways, championing hand washing between obstetrical exams before Semmelweis and others made this a common practice. This statement on less than full disclosure, however, was reflective of the medical paternalism of his era, not a revolutionary position.

Immanuel Kant and Edmund Pellegrino would both stand starkly against this style of communication, but Beauchamp and Childress’ Principlism and Bentham and Mill’s Utilitarianism might support deception if the healthcare professional is convinced that beneficence and the greatest good to the greatest number of people outweigh the potential harm of the lie. Neither of these latter two philosophies go so far as to openly encourage lying. The sticking point is that both depend upon predictions regarding outcomes of actions that are unknowable.

Having said all the above, assuming we opt for open, honest dialogue, a further question arises. Sometimes we think we know what the outcome of a procedure or treatment will be, or the cause of a negative outcome, only to discover later we were incorrect. If we have told a patient confidently that X or Y will or will not happen or that A or B was caused by a given mistake, for instance, only to find out this isn’t true, the patient or family may view the negative outcome or our explanation of it as a lie or excuse and may lose trust in us. If a patient or family is demanding immediate answers, we may offer hypotheses or conjecture before we know firm facts. It is important to not overstate potential positive outcomes, understate potential complications or give a premature explanation for negative outcomes as they arise. Additionally, if we are not responsible for complications or unintended outcomes, it may be someone else’s obligation to discuss such outcomes. Accusations within the medical team may prompt legal actions, and accusers frequently don’t have all the medical information regarding factors that have caused negative outcomes.

A more common form of deception, and one to which many are prone, is seen in informed consent discussions or, perhaps more accurately, informed, shared decision-making. Do we exaggerate the importance of making a medical choice that we see as most beneficial when, in fact, there may be several acceptable options with potentially similar outcomes? While we have moved from Osler’s paternalism, we often feel ethically or medically compelled to push hard for a specific course of action when there may be several choices. We don’t want to move to a doctor-as-technician form of communication, but we can easily move from wisely guiding and attempting to persuade to a form of coercion, bending the truth. When is it truly appropriate to tell a patient, “This is the only course of action,” or even, “This is clearly the best course of action?”

Similarly, if a patient asks, “What would you do in this situation?” it may be inappropriate and almost irrelevant to answer in a straightforward manner. There are many differences between the healthcare professional and the patient, and personal values and goals frequently direct choices. A better way to engage this question might be to clarify outcomes the patient/family deem acceptable. In weighing risks versus benefits, personal values matter. A person whose entire identity is tied to public speaking and teaching may be unwilling to assume even minimum risk if these skills are jeopardized. A concert pianist may have different values than a professional athlete. A scholar might value preservation of cognition above ability to walk. Clarifying patient values, instead of assuming one’s own values, helps to guide risk/benefit discussions.

A further distinction is that of clearly outlining the clinical details, treatment options and likely outcomes, versus absolute full disclosure of all possible details. Does an abundance of facts, opinions and hypotheses help clarify complex questions, or does it just muddy the waters? How much information is enough? Yet, if unexpected outcomes occur that were not disclosed prior to decision making, will the patient feel they were not given enough information to make correct decisions? Will this be seen as a form of deception? If a reported complication occurs in less than one in a 1,000 patients, must it be discussed? Historically, many consent forms listed death and permanent disability as possible outcomes for even the most minor procedures. Does this make sense?

What about near-miss incidents? If the pharmacy sends the wrong medication to the floor, but a nurse catches the error and corrects it prior to administration, should the patient be informed? If no harm has occurred, the system needs to be re-examined, but will the patient benefit from knowledge of the near-miss, or will this only provoke anxiety and distrust? Conversely, if the patient or family learn of the near-miss after the fact, will they believe they were deceived as to the quality of care? There is no malpractice risk as no harm was done, but there may be damage to trust.

So, this simple question of truth telling may be more complex than at first blush, but there are some principles that we can practice and teach to the next generation of healthcare professionals:

• Blatant lies are never ethical.
• Confidence in one’s abilities is good, but overstating one’s abilities or knowledge is not, and it can be dangerous to patients and healthcare professionals.
• Framing expectations of outcomes and desired results of treatment options goes a long way toward making good choices in patient care.
• Promising outcomes is foolish. Promising best effort is mandatory.
• The most honest thing to say to patients/families is often, “I don’t know for sure, but I’ll try to find out for you.”
• The phrases, “I believe…” and “In my opinion…” are important qualifiers that keep lines of communication open.
• Assigning blame to oneself or others for poor outcomes before one has all the information is unwise and can be dangerous. It is better to meet with the injured parties, assure them you will get more information and keep your word in getting back to them when you know more.
• If you become convinced another healthcare professional has erred in a way to injure a patient, it should not be ignored, but it may not be your role to inform the patient or family of your thoughts. Cover-ups are unethical, but so is racing to judgment. Full investigation, in coordination with Quality Assurance and Risk Management, should precede full disclosure.

References

• Zolkefli Y. The ethics of truth-telling in health-care settings. Malays J Med Sci. 2018;25(3):135-139
• https://journalofethics.ama-assn.org/article/truth-telling-patient…
• The Journal of Rheumatology 2024; 51:730-731 doi:10.3899/jrheum.2024-0162
• https://annsilvers.com/blogs/news/ how-do-they-lie…
• BOOK: Curlin F and Tollefsen C, (2021), The Way of Medicine. Ethics and the Healing Profession. University of Notre Dame, Notre Dame, IN.