Truth-telling in psychiatry

Truth-telling has been part of one of the great bioethical shifts of the 20th century, from medical paternalism to respect for patient autonomy. Some argue that there are psychiatric cases where truth-telling is less necessary, however. The three standard justifications for medical deception – that the truth can be anti-therapeutic, that patients don't want to know the truth, and that telling the truth is ultimately impossible – seem to be more compelling in psychiatry, and there are additional justifications that apply when psychiatric patients lack the capacity to make their own decisions. Here, I consider those justifications, and argue that truth-telling is paramount even in psychiatry.