Therapeutic privilege and the right not to know
- Topic
Rarely, a doctor may withhold information if telling it would cause serious harm; and a patient may ask not to be told.
What it is
Therapeutic privilege lets the doctor withhold information when there is compelling evidence that disclosure would cause real and foreseeable harm to the patient, for example turning a depressed patient actively suicidal. It is a very narrow exception and easy to abuse: sad news or a family's request is not enough. The right not to know is different: a capable patient may decide, in an informed way, not to receive certain information, or that someone else receives it and decides for them. In Colombia, Law 23 of 1981 asks doctors to avoid comments that cause worry (art. 11), but Law 1751 of 2015 guarantees enough information to decide.
Therapeutic privilege versus the right not to know
| Feature | Therapeutic privilege | Right not to know |
|---|---|---|
| Who decides | The doctor | The patient |
| Basis | Avoiding serious, foreseeable harm | Respect for autonomy |
| How often | Very rare | Uncommon but legitimate |
| Requirement | Evidence of harm, recording and review | An informed, free decision by a capable patient |
In clinical practice
- «Doctor, I don't want the details; talk to my son»: respect it, record it and offer to talk again whenever the patient wishes.
- A patient with severe depression and suicidal ideation: part of the information may be delayed while they are protected, not hidden indefinitely.
- The privilege does not allow a procedure without anyone's consent: if the patient is not informed, a surrogate decides.
- Ask from time to time whether the patient wants to know more.
Legal framework in Colombia
- Law 23 of 1981, art. 11: supportive attitude and avoiding comments that cause worry; art. 18: in serious situations, inform relatives or close persons and the patient when that helps resolve their problems.
- Decree 3380 of 1981, art. 11: the doctor is excused from warning of the foreseen risk if the patient's mental state and the absence of relatives prevent it, or in an emergency; art. 12: this must be recorded in the medical record.
- Law 1751 of 2015, art. 10 d): right to clear, appropriate and sufficient information to decide.
- Official texts checked on 2026-11-05 at funcionpublica.gov.co.
Test yourself
Think of the answer, then tap the question to see it.
When is therapeutic privilege justified?
Only when there is compelling evidence that disclosure would cause real, foreseeable harm to the patient, such as an active suicide risk.
Is hiding a diagnosis because the family asks a case of therapeutic privilege?
No. The family's request or sad news is not enough; talk with the family and ask the patient how much they want to know.
How does the right not to know differ from therapeutic privilege?
In the right not to know the capable patient decides, out of autonomy; in therapeutic privilege the doctor decides, to avoid serious harm.
What does Decree 3380 of 1981 require when the doctor cannot warn of the foreseen risk?
Recording in the medical record that the warning was given or why it could not be (article 12).
Connections
Educational content on ethics and health law; not legal advice. Laws and case law change: each page links the official text and says when it was last checked. For a real case, read the text in force and ask a lawyer or the medical ethics tribunal.
Sources: Truth-telling and Withholding Information (University of Washington, Department of Bioethics & Humanities, 2018); Informed Consent (University of Washington, Department of Bioethics & Humanities, 2018); Ley 23 de 1981, por la cual se dictan normas en materia de ética médica (Función Pública, Gestor Normativo, 1981); Decreto 3380 de 1981, por el cual se reglamenta la Ley 23 de 1981 (Función Pública, Gestor Normativo, 1981); Ley Estatutaria 1751 de 2015, que regula el derecho fundamental a la salud (Función Pública, Gestor Normativo, 2015).
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Representative model, for educational purposes only.