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Ethical Justifications and Critiques of Deception in Clinical Medicine

Introduction

Background

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Deception in clinical medicine includes practices such as:

  • Lying or false reassurance
  • Withholding diagnostic or prognostic information
  • Placebo or nocebo administration
  • Covert medication
  • Limited or symbolic resuscitation (“slow codes”)

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Modern medical ethics prioritizes patient autonomy, transparency, and informed consent. However, clinicians sometimes engage in deception to:

  • Reduce patient distress
  • Promote treatment adherence
  • Protect patient privacy
  • Navigate systemic barriers such as insurance limitations

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These practices remain ethically controversial within bioethics scholarship.

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Problem

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There is no clear consensus regarding when, if ever, deception is ethically permissible in clinical care.

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Research Question

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How is deception conceptualized, categorized, and ethically evaluated in the bioethics literature?

Aims and Objectives

Aim

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To characterize how deception in clinical medicine is discussed and evaluated in the bioethics literature.

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Objectives

  1. Identify the major types of deception described in clinical contexts
  2. Examine who performs deception and who is affected
  3. Analyze ethical arguments supporting or opposing deceptive practices
  4. Develop a categorized repository of deception cases discussed in bioethics scholarship

Hoon Oh¹, Reba Aldaire¹, Abram Brummett, Ph.D., HEC-C²

¹Oakland University William Beaumont School of Medicine

²Department of Foundational Medical Studies, Oakland University William Beaumont School of Medicine

Methods

Study Design

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Scoping review of peer reviewed bioethics literature.

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Literature Identification

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Articles were identified through database searches and manual review of bioethics scholarship discussing deception in clinical medicine.

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Inclusion Criteria

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Articles were included if they:

  • Described or analyzed deception in clinical care
  • Presented ethical arguments regarding deception
  • Discussed real or hypothetical clinical cases

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Data Extraction

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Each article underwent structured extraction for:

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  • Type of deception
  • Target of deception
  • Actor performing deception
  • Ethical arguments presented
  • Author conclusions regarding permissibility

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Deception Categories

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Articles were grouped into major categories including:

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  • Therapeutic privilege
  • Covert medication
  • Placebo or nocebo use
  • Slow code resuscitation
  • Other forms of deception identified during analysis

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Analytic Approach

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Extracted cases and arguments were coded and summarized to identify patterns in:

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• Deception types

• Ethical justification frameworks

• Author positions on permissibility

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Dataset

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99 bioethics articles were included in the final analysis.

Results

Figure 1. Distribution of Deception Categories in the Bioethics Literature (n = 99)

Distribution of deception types identified in the reviewed literature. Therapeutic privilege (22 articles) was the most frequently discussed category, followed by covert medication (16), placebo or nocebo use (10), slow code resuscitation (4), mixed categories (11), and other forms of deception (36).

Table 1. Author Ethical Positions Regarding Deception in Clinical Medicine

Author conclusions regarding the ethical permissibility of deception in the reviewed literature (n = 99 articles).

Author Conclusion

Number of Articles

Deception may be ethically justified in some cases

65

Deception ethically impermissible

18

No clear conclusion

16

Major Types of “Other” Deception Identified

  • Diagnostic or prognostic nondisclosure
  • Insurance and institutional deception
  • Genetic and familial secrecy
  • Environmental deception in dementia care
  • Cultural models of truth telling

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Conclusions

  • The bioethics literature demonstrates significant disagreement regarding deception in clinical medicine.

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  • Many authors argue deception may sometimes be justified to:
    • Prevent psychological harm
    • Protect patient privacy
    • Address structural barriers to care

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  • Critics emphasize risks including:
    • Violations of patient autonomy
    • Erosion of clinician–patient trust
    • Professional integrity concerns

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  • Deception in clinical practice is complex, context dependent, and ethically contested.

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Implication

Clearer ethical frameworks are needed to guide clinicians facing situations where deception may arise.

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Future Directions

  • Development of clinical guidelines addressing deception
  • Empirical research on patient perspectives regarding deception

References

  1. Brummett A, Salter EK. Mapping the moral terrain of clinical deception. Hastings Cent Rep. 2022;52(6):10-18.
  2. Meyers C. Justifying clinical deception: some amendments to Brummett and Salter. Hastings Cent Rep. 2022;52(6):19-21.
  3. Wasserman JA. Deception, pain, and placebo: applying the Brummett-Salter deception framework. Hastings Cent Rep. 2022;52(6):22-24.
  4. Lantos JD, Meadow WL. Should the “slow code” be resuscitated? Am J Bioeth. 2011;11(11):8-12.
  5. Meyers C. Deception and the clinical ethicist. Am J Bioeth. 2021;21(11):85-87.

Acknowledgements

The authors thank Dr. Abram Brummett, Ph.D., HEC-C for mentorship, guidance, and feedback throughout this project.

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This work was completed as part of the Embark Capstone Program at Oakland University William Beaumont School of Medicine.