The ethics of disclosure: How an ethical decision making framework can contribute to determining when disclosure is appropriate

Viewing disclosure as a prima facie obligation within the medical and research settings, an ethical decision-making framework is developed to assist physicians and researchers in making difficult disclosure decisions.;Beginning with the theory of new casuistry, the decision-making framework utilizes paradigm cases to compare to less obvious disclosure decisions. The normative theory of principlism--including the principles of autonomy, beneficence, veracity and justice--is discussed within the decision-making framework. Applying the decision-making framework to new disclosure issues also helps specify the disclosure obligation.;The decision-making framework suggests analyzing cases to determine if nondisclosure is justifiable based on: (1) whether it is necessary to infringe upon the disclosure obligation to achieve the goal supported by nondisclosure; (2) whether violating the disclosure obligation will be effective in meeting the competing goal; (3) whether the goal of nondisclosure is proportional or important enough to justify overriding the disclosure obligation; (4) whether the disclosure decision is designed to minimize infringement upon the disclosure obligation; and (5) whether the proper process was used.;The decision-making framework is exemplified in four paradigm cases. The first two paradigm cases relate to the medical setting and include an application of the decision-making framework to cases involving whether to disclosure a medical error involving medication to a patient and whether to disclose a physician's HIV status to his patients. The final paradigm cases relate to the research setting and apply the decision-making framework to whether subjects should be provided with risk information after the conclusion of a study and whether interim research results should be provided to subjects.;The decision-making framework is then applied to less-settled disclosure cases in the medical and research settings. The medical cases raise issues related to physician impairment, a near miss related to a medication mix-up, and covert video surveillance for suspected Munchausen Syndrome. The research cases raise issues about the disclosure of a prescription's off-label status, obtaining research results after a subject has waived their right, and disclosure of alternatives to research enrollment.;This study concludes the decision-making framework would be strengthened by further empirical research into patient responses to various disclosure scenarios.