Withholding policies from patients restricts their autonomy

doi:10.1136/bmj.331.7524.1078

BMJ 2005;331:1078-1080 (5 November), doi:10.1136/bmj.331.7524.1078

Education and debate

Withholding policies from patients restricts their autonomy

Charlotte Williamson, member of board of trustees, Picker Institute¹

¹ Dalby Old Rectory, Terrington, York YO60 6PF charlotte@wmsn.freeserve.co.uk

Keeping clinical information about themselves from patientsis now considered unacceptable, but transparency about clinicaland institutional policies that may affect care is less universal

The first 150 words of the full text of this article appear below.

Introduction

Patient autonomy is regarded as a basic value for modern healthcare in Western countries.¹ The UK regulatory body, the GeneralMedical Council, states that patients must be given enough informationto enable them to give informed consent to treatment.² It doesnot, however, state whether patients must be told about allthe procedures or treatments that might help them or only thoseprovided locally.² Yet policies about what information to offeror to withhold are crucial to patients' autonomy. In this articleI show the harm that can be caused by withholding informationabout policies from patients and discuss some of the ethicaland political issues.

Importance of policies

Policies set the context, the opportunities and limits, withinwhich clinical care is provided. They shape health professionals'behaviour, sometimes for decades.³ They may be written downas statements of instruction or as guidelines. Or they may bewhat every member of a . . . [Full text of this article]

Ethical implications

Withheld policies

Political implications

What can doctors do?

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