title: Physicians' silent decisions: because patient autonomy does not always come first.
abstract: Physicians make some medical decisions without disclosure to their patients. Nondisclosure is possible because these are silent decisions to refrain from screening, diagnostic or therapeutic interventions. Nondisclosure is ethically permissible when the usual presumption that the patient should be involved in decisions is defeated by considerations of clinical utility or patient emotional and physical well-being. Some silent decisions--not all--are ethically justified by this standard. Justified silent decisions are typically dependent on the physician's professional judgment, experience and knowledge, and are not likely to be changed by patient preferences. We condemn the inappropriate exclusion of the patient from the decision-making process. However, if a test or treatment is unlikely to yield a net benefit, disclosure and discussion are at times unnecessary. Appropriate silent decisions are ethically justified by such considerations as patient benefit or economy of time.
authors.affiliation: Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX 77098-3926, USA. swhitney@bcm.edu
authors.forename: Simon N
authors.initials: SN
authors.lastname: Whitney
authors.forename: Laurence B
authors.initials: LB
authors.lastname: McCullough
mesh_terms: D000152:Acne Vulgaris / Q000188:drug therapy; D000328:Adult; D000544:Alzheimer Disease; D003268:Contraception Behavior; D003362:Cost-Benefit Analysis / Q000941:ethics; D003657:Decision Making / Q000941:ethics*; D026690:Ethics, Clinical; D004992:Ethics, Medical; D005260:Female; D006261:Headache / Q000175:diagnosis; D006801:Humans; D015474:Isotretinoin / Q000009:adverse effects / Q000627:therapeutic use; D008297:Male; D008403:Mass Screening / Q000941:ethics; D010358:Patient Participation; D026684:Personal Autonomy; D011471:Prostatic Neoplasms / Q000517:prevention & control; D013723:Teratogens; D014342:Truth Disclosure / Q000941:ethics*
chemical_list: D013723:Teratogens; D015474:Isotretinoin