Bullock Argues for Medical Information Disclosure on a Case-By-Case Basis

March 9, 2015

In a faculty research seminar at the School of Public Policy (SPP) on March 6, Assistant Professor Emma Bullock (CEU Department of Philosophy and CELAB) presented her research on mandatory disclosure and medical paternalism. Bullock laid out theoretical arguments for context-sensitive paternalism over mandatory disclosure.

According to Bullock, the policy of mandatory disclosure of medical information to patients is an unjustified form of paternalism. While the intention of mandatory disclosure is to provide necessary information for patients so they can make meaningful and autonomous decisions, Bullock argues that this policy is not justified under the framework of either epistemic or general paternalism.

Proponents for mandatory disclosure arguing from an epistemic paternalism perspective claim that this policy allows patients to exercise their autonomy in an informed, meaningful way. However, Bullock counters there are a number of reasons why patients might not be making informed decisions even after receiving medical information including publication biases in the medical field against negative trial results, a relatively high incidence of misdiagnoses, non-compliance with evidence-based guidelines by doctors, and the intrinsic uncertainty of medicine.

Those who adopt a general paternalism perspective argue that patients are better off, i.e. they have better health outcomes, when there is mandatory disclosure. Bullock points out, however, that it is difficult to know whether all patients are better off when they receive medical information. Some information, particularly related to serious conditions, can result in undesirable conditions including depression and increased anxiety.

“A blanket principle like mandatory disclosure does not suit all cases,” said Bullock. With context-sensitive paternalism, Bullock argues that doctors must consider patient preferences for information disclosure as well as the consequences of disclosing this information. “This theory recognizes that patient preferences might be relevant, and it allows for greater flexibility than mandatory disclosure.”

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