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Withholding a Diagnosis

The family of a competent 80-year-old man with a new lung cancer diagnosis asks you not to tell him the truth, testing your ability to uphold patient autonomy.

  1. 1
    Briefing
  2. 2
    Simulation
  3. 3
    Feedback

How This Works

This is an interactive phone call simulation. You'll speak with Susan in a realistic clinical communication scenario.

1. Start Call

Click "Start Call" when you're ready. Speak naturally as you would on a real call.

2. Have the Conversation

10 minutes to complete the call. The AI responds in real-time to what you say.

3. Get Feedback

End the call when finished. You'll receive AI-powered feedback on your communication.

💡 Tip: Speak clearly and at a natural pace. If you need a moment to think, it's okay to pause briefly - just as you would in a real conversation.

Briefing Details

1. Learning: Patient Autonomy vs. Family Wishes

Purpose of this Scenario

This scenario focuses on a classic ethical dilemma: a family's well-intentioned request to withhold information from a competent patient. This often stems from a loving desire to protect a family member from emotional distress. However, the ethical and legal principle of patient autonomy dictates that a competent adult has the right to know about their own health. Your task is to navigate this conflict with empathy for the family's position while firmly upholding your duty to the patient.

Key communication strategies include:

  • Acknowledge the Loving Intent: Start by validating the family's motive. "It is so clear how much you love your father and want to protect him from pain."
  • Gently State Your Ethical Duty: Clearly but gently explain your obligation to the patient. "I understand your concern. However, my primary responsibility is to your father, and he has a right to know about his own health so he can make decisions."
  • Explore Their Fears: Ask about the 'why' behind their request. "Can you tell me more about what you're worried will happen if we tell him?" Often, this reveals fears that can be addressed (e.g., "he'll give up hope").
  • Form a Partnership: Frame the conversation as a collaboration. "Let's talk about how we can tell him together, in a way that is as gentle as possible and gives him the support he needs."

2. Scenario Briefing

Your Objective

You are the hospital physician. A biopsy has just confirmed that your 80-year-old patient, Mr. Smith, has lung cancer. He is alert, oriented, and has full decision-making capacity. As you are about to enter his room to discuss the results, his daughter, Susan, pulls you aside. Your objective is to have a conversation with Susan about her request to withhold the diagnosis from her father.

Patient & Family Background

Your patient is Mr. Smith, an 80-year-old man admitted for a lung mass workup. His daughter, Susan, is his healthcare proxy and is very involved in his care.

The Conflict: Susan pulls you aside and says, "Doctor, before you go in there, I need to ask you something. Please, don't tell him he has cancer. The news will crush him. Just tell him it's a bad pneumonia that needs strong medicine."

Key Medical & Ethical Facts

  • Diagnosis: Biopsy confirmed non-small cell lung cancer.
  • Patient Capacity: The patient has full decision-making capacity.
  • Ethical Principle: A capacitant patient has the right to be informed about their diagnosis, prognosis, and treatment options. Withholding this information is an ethical violation.

Learning Objectives

Optional prep details

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Optional Pre-Call Knowledge Check

Optional self-check before you start

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After completing this scenario, you will be able to:

  • Analyze the ethical conflict between the principle of patient autonomy and the family's request for non-disclosure.
  • Articulate the legal and ethical rationale for prioritizing a competent patient's right to be informed about their diagnosis.
  • Formulate a communication strategy to explore the family's underlying fears and motivations for their request.

For a patient who is determined to have decision-making capacity, which ethical principle is generally considered paramount regarding the disclosure of their diagnosis?

What is the most appropriate first step when a family asks you to withhold a serious diagnosis from a competent patient?

Which of the following is NOT a required element for assessing a patient's decision-making capacity?