Charles B. Simone, M.D., Nicole L. Simone, B.S.E.,
Charles B. Simone, II Lancet. 1998; 352: 1787.

Hassn and Hassan wrote their opinion that "the wish of patients to know the whole truth about their illness does not mean that it is right for them... on the contrary, it harms many of them"(1). However, a survey found that 96 percent of Americans wanted to be told if they had cancer and 85 percent wanted to know how long they would live if their cancer usually led to death in less than a year (2).

Moreover, a legal case involving ethical informed consent (Arato v. Avedon [3]) asked whether the law should force physicians to report statistical life expectancy information to patients. Mr. Arato had pancreas cancer that was treated surgically, then with experimental chemotherapy and radiation because there "is no effective treatment." The surgeon and oncologist never told Mr. Arato and his wife that only 5 percent survive for 5 years, nor did they give a prognosis or estimate of his life expectancy, nor were they asked. A recurrence occurred and the physicians knew he would die within a few months, but did not tell the patient about life expectancy. The patient died and his wife sued the physicians claiming that the doctors were obligated under California’s informed consent law to tell the patient about survival figures before asking him to consent to chemotherapy. The court decided Mr. Arato should have been informed. The physicians said if the patient knew of the high mortality rate, he would have no hope. And during the 70 visits, the patient did not ask questions about his life expectancy indicating to the physicians that he did not want to know. The patient’s wife said had the patient known the facts, he would have declined all treatment and attended to his business affairs. His wife incurred tax losses due to poor business planning.

The lower court favored the physicians. The appeal court reversed the decision. The California Supreme Court upheld the decision in favor of the wife because of the doctrine of informed consent based on four tenets:

1. Patients are generally ignorant of medicine.
2. Patients have a right to control their own bodies and thus to decide about medical treatment.
3. To be effective, consent to medical treatment must be informed.
4. Patients are dependent upon their physicians for truthful information and must trust them (making the doctor-patient relationship a "fiduciary" or trust relationship rather that an arm’s length business relationship).