"Please don't tell her it's cancer" — the relative's request
PLAB 2 & PRES 3 · ethics / communication skills · hard · 10 minutes
Candidate brief
You are an FY2 doctor on a medical ward. Mrs Helen Marsh, 68, was admitted with obstructive jaundice. Her CT and bloods now show a pancreatic head mass, highly likely pancreatic cancer, with liver lesions. Biopsy results are awaited to confirm. She is comfortable, eating, and keeps asking when she can go home. Her son, David, has asked to speak to you privately before you see her. He says: "Mum mustn't be told it's cancer. When Dad died of it she said she'd rather not know if it ever came for her. Knowing will destroy her — she'll just give up. Tell her it's a blockage, an inflammation — we'll handle the rest as a family. And she mustn't find out from anyone else either." Please manage this conversation, and set out what you will do next.
What examiners look for
Collusion requests are always grief wearing a logistics costume. The son is asking you to protect his mother from a sentence he has already heard once — explore that history before you touch the ethics, because a relative who feels unheard escalates, and a relative who feels heard can usually be brought to the honest plan. The ethical core is simple: the information is the patient's. Her autonomy includes a right to know and a right not to know — but both rights are hers, exercised now, by her. A family can no more donate her ignorance than they can donate her consent. The 25-year-old remark is evidence of a wish worth exploring with her, not a contract the team must execute in silence. Therapeutic privilege exists in the textbooks and almost never in the ward: withholding a diagnosis because the truth will distress is not withholding because disclosure would cause SERIOUS harm — and distress at bad news is the normal human response the whole breaking-bad-news craft exists to hold. If distress alone justified deception, no cancer diagnosis could ever be given. Practise the pivot sentence: "I can't promise to lie to her — but I can promise we will never dump this on her. We'll ask her how much she wants to know, and she'll set the pace, with you beside her." It refuses the collusion, keeps the son's real need (gentleness), and gives him something true to hold. Finally — secrets in hospitals rot. Biopsies, MDTs, letters, portals, three shifts of nurses: a family conspiracy becomes a discovery scene within days, and patients who discover deception lose trust in every subsequent professional who offers help. The honest conversation, at her pace, is not just the ethical choice; it is the only one that survives contact with reality.
Guideline references
- https://www.gmc-uk.org/professional-standards/the-professional-standards/decision-making-and-consent/the-seven-principles-of-decision-making-and-consent
- https://www.gmc-uk.org/gmpinaction/case-studies/mr-hartley/scenario-01
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