Intended for healthcare professionals

Education And Debate

Withholding policies from patients restricts their autonomy

BMJ 2005; 331 doi: (Published 03 November 2005) Cite this as: BMJ 2005;331:1078
  1. Charlotte Williamson, member of board of trustees, Picker Institute (
  1. 1Dalby Old Rectory, Terrington, York YO60 6PF
  • Accepted 25 July 2005

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


Patient autonomy is regarded as a basic value for modern health care in Western countries.1 The UK regulatory body, the General Medical Council, states that patients must be given enough information to enable them to give informed consent to treatment.2 It does not, however, state whether patients must be told about all the procedures or treatments that might help them or only those provided locally.2 Yet policies about what information to offer or to withhold are crucial to patients' autonomy. In this article I show the harm that can be caused by withholding information about policies from patients and discuss some of the ethical and political issues.

Importance of policies

Policies set the context, the opportunities and limits, within which clinical care is provided. They shape health professionals' behaviour, sometimes for decades.3 They may be written down as statements of instruction or as guidelines. Or they may be what every member of a clinical service knows informally. Policies are so taken for granted by many health professionals that if patients question some aspect of care, they may simply be told, “It's hospital policy” as a barrier to further questions, discussion, or negotiation.4 Policies are part of the situation in which patients find themselves, whether in hospital or in their general practitioner's surgery. So arguably, patients who might be affected by specific policies should be told about them.

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Patients need policy information to make informed decisions about their treatment


This does not always happen because information for patients is contentious. Doctors and patient representatives (patients speaking for the interests of other patients5) often hold passionately opposed views about what …

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