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Over the years, the concept of the 'right to the truth' has become well established in medical ethical practice. This concept was first used in debates over the patient's right to know the doctor's diagnosis regardless of its seriousness, and then later expanded to the broader concept of informed consent. Currently, informed consent requires the doctor to disclose 'any facts which are necessary to form the basis of an intelligent consent by the patient to the proposed treatment'. 1 Thereafter, 'facts which are necessary' were characterised. Thus, informed consent requires disclosure of: (1) the diagnosis; (2) the nature and purpose of the proposed intervention; (3) the probable risks and benefits associated with the intervention; (4) alternatives to the proposed intervention, including the risks and benefits associated with each option; as well as (5) the consequences of refusal or non-intervention. This therefore implies that the right to the truth involves informing the patient of all the facts so that an informed decision can be made. In practice, however, regardless of the interpretation given the application of this concept poses major difficulties.
First, the very idea of a 'right to the truth' is not without a certain amount of ambiguity. Especially in the context of constantly evolving medical knowledge and practice, what meaning should be attributed to the word 'truth'? In particular, are we really dealing with the 'truth' when evidence-based medicine is expressed in terms of probabilities rather than absolutes? How can probabilities be reconciled with the patient's own world of truth, his hopes and expectations, especially if the data lean towards the 'unlikely'? Furthermore, this constantly evolving research-based evidence reflects only our current state of knowledge, whereas new research could easily suggest a more recent 'truth'. Despite undeniable scientific advances, the uncertainty inherent in medical practice persists because of the 'incomplete state of medical knowledge', coupled with the difficulties of mastering clinical reasoning. 2 3 Thus, the nature of the problem, the varying presentations of the clinical picture, the limits of the patient's narrative, the multiple biases of the various clinical reasoning strategies, 4 the ever-expanding body of medical knowledge, as well as the finite nature of human rationality, explain an unavoidable element of uncertainty in medical decisions and numerous obstacles for medical judgement that...