Does not know the diagnosis but is stressed about what it might be

Recently diagnosed the patient with metastatic cancer and needs to determine management plan

Does not want the patient to be told she has cancer on the basis that it will cause her distress

Would interfere with his planned trip.

Concern that the patient and his wife would suffer psychological harm.

Allows the patient and his wife to decide if the trip is still important to them.

Allows the patient to make an informed an autonomous decision on what type of treatment he would like and decide his priorities.

Spares the patient the inconvenience of suffering advancing symptoms while traveling.

Language barriers

Strong influence on the patients decisions

Lack of time

Lack of appropriate place

Reluctance to be told bad news

Fear that disclosure of a bad prognosis can be interpreted as a confession of inability

Cognitive impairment

Lack of specific education and clear guide-lines

Difficulties to handle patients' emotional reactions

Not feeling comfortable, taking away hope from patients

Effort of protecting the ill member from feelings of hopelessness

Severe illness and negative emotional states can compromise a patient's capacity for autonomous decision-making, because the experience of pain, fear and anger, prevent them from "taking in" all the relevant information.

Informed consent requires the patient to have full knowledge of their condition and the available options

Withholding information may result in a heightened state of fear, anxiety and confusion. It may add considerably to a patient's distress and prolong the necessary adjustment process thereby causing harm.

If disclosure of certain information is deemed to cause the patient excessive distress and emotional harm, the doctor may be justified in withholding such information.

The patient needs to be fully informed of their medical condition in order to be able to make autonomous decisions without manipulation.