Fully informed consent can be needlessly cruel.

Abstract

...After many years of experience as committed trialists and\nbelievers in the statistical and clinical value of the randomised clinical\ntrial, we feel that uniform recommendation for full written informed consent,\nas outlined for example by the Royal College of Physicians, may be not only\nbad for clinical trials but, far more important, unnecessarily cruel to\npatients....We suggest that the process of informed consent should be viewed\nas another straightforward instance in which the clinical judgment of the\ndoctor is paramount. Clearly, for a patient who wishes to know what underlies\nall aspects of decision making, there is no doubt that a full explanation\nshould be given, together with all the necessary information about the trial.\nAt the other extreme a distraught patient, possibly within days of diagnosis\nof a potentially lethal illness, may be unable to take in any but the most\nbasic details....The counter argument will be that we are advocating a\npaternalistic "doctor knows best" approach. We are not. We wish to see this\ndiscussion with the patient informed by the same wisdom, judgment, and\nkindness which should be part of all aspects of clinical care. We believe that\nthe ethical pressure that has put us so much on the defensive is\nflawed....