Tragic knowledge: truth telling and the maintenance of hope in surgery

Surgeons often are faced with the challenge of balancing truth telling and the maintenance of hope in the setting of a poor prognosis. This ethical dilemma is informed by conflicting appeals to principles of autonomy and nonmaleficence, where a patient's right to be told important medical information must be weighed against the potential harm that may result from the knowledge of an unfavourable diagnosis. Truth telling in surgery raises questions on the nature of truth itself, how much information ought to be shared, what information can be withheld, and how surgeons should share tragic knowledge with patients. This paper will address these questions and provide some insight on how surgeons may navigate the sharing of tragic knowledge.