SMLE Ethics Case: When Family Asks You to Hide a Diagnosis

A family member asks you not to tell a patient about a serious diagnosis. The question is how to establish what the patient wants while communicating honestly and sensitively. Work through the case, then compare your reasoning with the explanation.

Where this case fits in the SMLE blueprint

The 2026 SCFHS blueprint's Ethics section, page 29, includes breaking bad news, patient privacy, confidentiality and informed consent. These topics establish the relevance of this case; they do not tell us how often this exact scenario appears.

The exam-structure section, page 3, specifies four options and one best answer. This practice case follows that format.

Practice case

A 68-year-old man attends an oncology clinic for his colonoscopy and biopsy results. The biopsy confirms colon adenocarcinoma with liver metastases. Before the consultation, his son asks the physician: “Please tell me everything, but do not tell my father he has cancer. I am afraid the news will harm him.”

The patient has decision-making capacity, and his communication preferences have not yet been established. What is the most appropriate next step?

1. Agree to withhold the diagnosis because the son is trying to protect his father.
2. Immediately disclose every detail to the patient without first asking his preferences.
3. Ask the patient how much information he wants and whom he would like involved.
4. Refer the case immediately to the ethics committee before speaking with the patient.

Why each option fits or fails

A — Agree to the son's request: this substitutes the relative's preference for the patient's. Listen to the concern, but do not assume that the patient wants information withheld or has authorised disclosure to his son.

B — Disclose every detail immediately: honest communication remains important. In this non-emergency scenario, however, first asking how the patient wants the results discussed is more responsive to the actual dilemma than delivering all details without checking his preference.

C — Establish the patient's preferences: this is the best answer. Ask the patient directly and privately, allow questions, and clarify whom he wants present or informed. A genuine wish for limited information or for a named person to receive it should be explored and respected.

D — Refer immediately: an ethics consultation may help with unresolved conflict or complex uncertainty. Here, the basic missing step is a conversation with the capable patient; that conversation should not be replaced by an automatic referral.

Best answer: C — ask the patient

The son's request tells you about his concern, not his father's wishes. Begin with the patient rather than choosing between a family-only conversation and a blunt disclosure. Agree on the level of detail, who may hear it and how to continue the discussion.

The AMA's guidance on withholding information supports eliciting genuine preferences and tailoring disclosure. The WMA International Code also addresses autonomy, consent and confidentiality. Use these ethical principles alongside applicable local professional rules; the SMLE blueprint identifies the examination topics rather than providing this vignette's answer key.

One way to phrase the conversation

With the son

“I can see that you are worried about how your father will cope. I need to understand how he wants his results discussed and whom he would like involved. Let us support him through that conversation.”

With the patient

“Before we discuss your results, how much detail would you like? Would you prefer to talk privately or have someone with you? Is there anyone you would like me to share the information with?”

These are example phrases, not a fixed script. Give the patient time to respond and check understanding before moving on.

Sharing information is not the same as handing over decisions

If the patient wants his son to hear some details first, clarify the scope of that permission and how the patient wants to participate in the next discussion. Do not infer from that request alone that the son can make every treatment decision. If the patient asks not to receive particular information, clarify the request without misleading him; agree how necessary discussions and follow-up will take place.

Record the preferences and permission to share, and revisit them if the patient wishes. If capacity becomes uncertain or disagreement persists, reassess the situation and seek appropriate clinical or ethics support under the institution's procedures.

A decision framework for similar cases

1. Identify the decision-maker: the stem establishes that this patient has capacity.
2. Find the missing information: his own communication and family-involvement preferences.
3. Protect confidentiality: establish permission before sharing clinical details with relatives.
4. Make a plan: communicate sensitively, check understanding and document what was agreed.

For a case involving another ethical communication decision, revisit your reasoning in the SMLE question bank. The study-plan guide explains how to record and review errors.

References

1. SCFHS 2026 SMLE Examination Content Guideline — Ethics, page 29: breaking bad news, privacy, confidentiality and informed consent.
2. SCFHS 2026 SMLE Examination Content Guideline — Exam Structure, page 3: four answer options with one best answer.
3. AMA Code of Medical Ethics, Opinion 2.1.3 — Withholding Information from Patients.
4. WMA International Code of Medical Ethics.