Openness with patients: a categorical imperative to correct an imbalance

This paper examines the concept of ‘openness with patients’ from the stand-point of the limitations of biomedical ethics. Initially we review contemporary critiques of bioethics and, in particular, of principlism; we relate how other; somewhat neglected, forms of medical ethics can yield useful information and provide moral guidance. The main section of the paper then shows how a bioethical approach to openness misses the social context in our example, the viewpoints of patients; we present some of the increasing wealth of research evidence which points towards patients wanting more information and a greater degree of openness. Finally we put forward that a principlist’s objection to active encouragement of openness might be based on the risk of infringing upon the ‘right not to know’. We reject this by arguing how rights can be trumped. Dr. Anthony S. Kessel, BSc, MBBS, Mphil, MSc, is a general practitioner, medical ethicist and currently specialist registrar (Barking & Havering Health Authority)/Honorary lecturer in public health medicine in the Epidemiology Unit, London School of Hygiene & Tropical Medicine, London, UK.