Prior to seeking consent to perform a clinical intervention, you will inevitably disclose information which the patient, or their family, will need to consider before deciding whether to agree with your proposal, so risks and benefits of and alternatives to your proposed clinical step need to be revealed. You cannot presume that the patient or their family will have any clue as to the anatomical pitfalls in a herniotomy; to the possibility of psychosis linked to some forms of antimalarial prophylaxis; nor the foreseeable consequences of interventional radiology.

Since disclosure is ubiquitous in the context of healthcare, the notion of clinicians seeking deliberately to avoid informing a patient of relevant medical information may seem scandalous. Unless viewed through the prism of ‘therapeutic privilege’.

In a case before the Supreme Court of Hawaii1 Dr Nishi, a dentist, who had ‘desperately wanted to know’ the source of his severe and unremitting chest pain, was rendered paraplegic by contrast medium used during thoracic aortography. He had been told that a thoracic aneurysm was foreseeable, but not made aware of the risk of the procedure; ‘…in part because of Dr Nishi’s psychological condition’. Dr Hartwell, the radiologist, described Dr Nishi as ‘…very well-educated, a fine man but in addition he was very frightened about his condition (a serious heart disease), he was apprehensive, and this actually guided our hand…if you frighten him further, you have …