Of the topics discussed so far, I think that the most challenging is finding a balance between truth-telling and therapeutic omission of information (that is, healthcare providers exercising “therapeutic privilege”). This is likely because trying to find a balance between these two results in essentially trying to find a balance between what many may consider to be axioms: “always tell the truth” and “do no harm when avoidable”.
(Note: This quality may not be unique to this challenging question, and perhaps most bioethical dilemmas spawn from attempting to balance two ideas which each ultimately represent axioms generally contended by society. It should be explored how cultures may be capable of adhering to, at times, conflicting beliefs. Perhaps it will be concluded that humans and moral law is simply not a law at all, and ethics as a whole is an attempt to match fluid, inconsistent morals with a strict, calculated system that will never actually be able to model it.)
Both of the sentiments, “always tell the truth” and “do no harm”, are powerful and their power is only enhanced when a position of authority is involved, such as a doctor. This is why this dilemma is especially challenging: because it is the doctor’s responsibility to do no harm, as per the Hippocratic Oath, but it is simultaneously expected that the information provided by doctors is entirely truthful. Generally, the motivation behind “always tell the truth”, is that providing the patient with all and entirely accurate information is going to maximize patient autonomy. However, I believe this dilemma can be better resolved by reexamining this assumption.
Let’s create a case that is representative of this dilemma, make determinations about the case and hopefully they may abstract to apply in general. Say an individual were nearly-fatally injured in a car accident and regained consciousness in the hospital and asked if their family members, also in the car at the time of the accident, were all right. Also suppose that the doctor being asked, informed that nobody else in the car survived, believes that the individual likely will not survive if they are told the full truth at that moment. A common argument for telling the truth would likely be that by not informing the individual the entire truth, the doctor would be limiting their autonomy by not allowing them to make the choice of whether they want to fight to live.
My approach to resolving this would be to claim that this argument is myopic, and in fact to temporarily sacrifice the individual’s autonomy would be to ultimately maximize it if the individual survives. This is because, by recognizing the patient’s condition, the doctor sees that fully informing the patient in the current moment would likely end in his/her demise, thus limiting their autonomy to choose whether they want to live or die. But informing the patient in the future, when their health has improved, would actually enable the patient full autonomy to choose whether they wanted to live or die (permitting suicide), given this information.