# Avoiding Deception and Nondisclosure in Clinical Practice: A Narrative Review of Ethical Principles, Legal Perspectives, and Communication Strategies

## TL;DR

This paper reviews ethical and legal aspects of deception in clinical practice and suggests communication strategies to promote transparency and trust.

## Contribution

The paper synthesizes ethical, legal, and communication approaches to address deception in clinical settings.

## Key findings

- Deception in clinical practice violates ethical principles like honesty and autonomy.
- Communication strategies like SPIKES and gradual disclosure can reduce distress while sharing sensitive information.
- Institutional policies and ethics training are vital for fostering transparency in healthcare.

## Abstract

Deception and nondisclosure in clinical practice undermine patient autonomy, informed consent, and trust in the physician-patient relationship. This review synthesizes ethical principles, legal frameworks, and communication strategies to address these issues, drawing on national and international guidelines. Deception, including lying, misrepresentation, and withholding critical facts, violates the principles of honesty, respect for autonomy, nonmaleficence, and justice, with significant implications for patient safety and public confidence. Factors contributing to such practices include therapeutic privilege, epistemic uncertainty, cultural norms, institutional pressures, and fear of litigation. Legal and professional standards, such as those from the Medical Council of Thailand, the American Medical Association, and the UK General Medical Council, mandate truthful and timely disclosure. Evidence-based communication approaches, including structured protocols like SPIKES, plain language use, and gradual disclosure, can help clinicians convey sensitive information while minimizing distress. Institutional measures, such as formal error disclosure policies, ethics training, and emotional support systems, are critical in fostering a culture of transparency. Sustained commitment to these principles is essential for upholding professional integrity, enhancing patient trust, and improving healthcare outcomes. This is a narrative review based on targeted searches of PubMed, Scopus, and Google Scholar, as well as professional guidelines and regulatory documents.