The point of departure in any treatment is to tell the patient the truth and not to decide for him what he should and should not know.

The reason for this is twofold: Telling the truth is a supreme moral value; and the patient himself requires all relevant information that will enable him to make informed decisions regarding his course of treatment. There are situations where it is not possible to provide him with the full information – such as when it has been assessed that his medical condition is likely to deteriorate significantly if he receives all this information, or if his condition has rendered him unable to understand the information he is given – that it is permitted to deviate from the basic position of telling the truth. For the ethical and practical considerations of providing or concealing information from him, see the footnote¹.

According to the law of the State of Israel, a patient must give “informed consent” to their treatment, and for this purpose he must be given the required medical information in full. The caregiver may refrain from providing information only if an ethics committee has confirmed that this may seriously harm the patient’s health².

1. One is obligated to tell the truth and refrain from falsehoods. The default position is that one must tell the truth; the truth may be concealed only if there are persuasive reasons to deviate from this principle³.

2. The patient is entitled to receive complete information about his illness, and it is the duty of the physician to provide this information. The information should be conveyed in a gentle manner, taking into account the patient’s state of distress⁴.

3. It is not only medical considerations that favor telling the truth – this approach will also enable the patient to settle his personal affairs, such as writing a will and other matters pertaining to his family and property⁵.

4. It is important to listen to the patient beforehand to find out how much he wants to know about his medical condition and adapt our responses accordingly. If a patient ignores the information or represses his awareness of his medical condition, his choices should be respected if no serious harm will result⁶.

5. In the case of a patient of unsound mind, we may hide information from him if it is determined that the truth will hurt him or that in his current situation he will fail to grasp its meaning⁷.

6. Even in the case of a patient with a clear mind, when there are genuine reasons to think that hearing information will harm him, the medical staff, together with the patient’s family, should consider withholding it in part⁸.

7. Even when it has been determined that the information should be withheld, this decision should be periodically reconsidered, as it is likely that the information will reach him in one way or another. Therefore, it should be anticipated that he will discover it anyway and reveal the information ourselves in an appropriate manner, gently and with sensitivity.

8. When it is necessary to hide the truth from a patient, a way should be found to avoid directly telling a lie, by merely avoiding providing him with the full, true answer to his questions. In extreme cases, one may also lie when it is necessary in order to calm the patient and there is no harm in doing so. However, one may not accustom himself to lying⁹.

9. If the patient’s relative passed away, and there is a concern that the patient’s condition might deteriorate if he hears this news, one should not inform him or fulfill the customs of mourning in his presence. However, if it is likely that the information will reach the patient by some other means, one should find the right time and conditions to tell him¹⁰.

10. If the patient has no chance of recovery and his death is imminent, one should propose to him to recite the confession, provided that there is no concern that the suggestion might harm his health. At earlier stages, confession should not be mentioned¹¹.

1. Apart from the value ​​of telling the truth and a person’s autonomy over his own body, there are practical reasons for not withholding information from a patient nowadays, when medical treatment includes complex procedures and involves various medical care providers, such that optimal cooperation is required between the various care providers and the patient. In order to establish the patient’s trust in the medical system, there must be an atmosphere of trust; if the patient suspects that he is being deceived, he may lose his trust in the staff. Furthermore, certain treatments require the patient’s active cooperation, and knowing the truth will increase their likelihood of success. In addition, the current reality is that doctors regularly give the patient information, and thus the patients are accustomed to it and are more prepared to deal with such information. Likewise, the fear of not knowing the truth may even cause psychological difficulty for the patient, whereas knowing the truth might enable the patient to undergo an emotional process culminating in acceptance, enabling him to cope better with his condition. Finally, in modern-day reality, withholding information is almost impossible, and therefore it is best for the patient to receive the information in an orderly and appropriate manner, rather than for him to be exposed to it inconsistently, in a potentially harmful fashion. To these factors we can add the legal consideration: A medical system that conceals information thereby exposes itself to the possibility of future lawsuits from the patient and his family.

   Conversely, there are ethical and practical considerations in favor of withholding information from a patient in certain situations. The basic duty of the medical staff is to maintain the patient’s health and to avoid causing harm. The principles ​​of truth and autonomy are not absolute, and it is possible that when it has been assessed that telling the truth will harm the patient, the value of life and its preservation takes precedence over those principles. Sometimes, knowing the truth can lead the patient to despair, depression and even suicide. Similarly, not knowing the truth can strengthen his hope, which in itself can help him recover. Some patients are not interested in having all of the information and choose to ignore reality or accept only part of it. In such cases, the doctor should respect the patient’s wishes and act accordingly. These considerations should affect not only the question of whether to tell, but also the manner of conveying the information, and the indispensable mediating role between the facts and the patient.

   See the Encyclopedia of Medicine and Halakha, vol. 2, “Revealing information to the patient,” pp. 479–512; Shimon Glick, “Reporting the Truth to the Patient,” Sefer Assia 7 (1994), pp. 15–22; Eran Segal, “Telling Patients the Truth: Should One Go All the Way?” MRM Risk Management Journal, 10 (2000), http://www.mrm.org.il/?categoryId=96896&itemId=221277; Sarah Ilan, Shimon Glick and Alan Jotkowitz, “Telling the Truth to Alzheimer’s and Dementia Patients in the Early Stages of the Disease,” HaRefua 153.9 (2012) pp. 537–40; Benjamin Gesundheit and others, “Telling the Truth to the Patient: A Discussion of the Jewish Sources,” HaRefua 153.10 (2014) pp. 613–16 (https://bit.ly/3jQlyxL).

2. The Patient’s Rights Act, 5756–1996.
3. Truthfulness is a noble and lofty principle, and the Torah not only prohibited lying but it even warned us to stay far away from it (which is not the case for other commands): “Keep far from a false matter” (Exodus 23:7). The Sages rated the telling of truth so highly that they said “the world stands upon three things – on judgment, on truth and on peace” (Mishna, Avot 1:18). Nevertheless, the Sages admit that the value of telling the truth is not absolute, and that “it is permitted for a person to depart from the truth in a matter that involves peace,” and it is even a mitzva to do so (see Yevamot 65b). There are many other examples mentioned in the Talmud and by the poskim of cases in which it is permitted and even a mitzva to depart from the truth when necessary. See the Responsa of the Rama, 11; Torah Lishma 364; 371. See also Rabbi Y. Cherlow, “Keep Far From a False Matter,” Tzohar, 1 (200) pp. 13–14 https://bit.ly/3qVLkVa; Encyclopedia of Medicine and Halakha, vol. 2, “Revealing information to the patient,” pp. 493–500. As we have written elsewhere, the point of departure must be that one should tell the truth. See a short response on the Tzohar LaEtika website, http://bit.ly/37B5om4.
4. The notion that information should be withheld from a patient in order to maintain his health can be found in several sources. According to a baraita in Moed Katan (26b), we do not inform a sick person that a relative of his has passed away, in case this drives him out of his mind, and the Shulḥan Arukh rules accordingly (Yoreh De’a 337:1; see subsection ix below). Although this is not a case of concealing medical information, it can be derived from here that in some situations an external party may determine that information should be withheld from the patient. The midrash in Kohelet Rabba (5) which deals with Hezekiah’s illness, indicates on the one hand that the common practice is not to tell the patient the true severity of his condition, to avoid driving him to despair, and whoever does otherwise is subject to criticism, while on the other hand, it also teaches that the main consideration is the good of the patient, and therefore if the medical assessment is that telling the truth will actually improve his condition, he should be told the truth. By contrast, a baraita in Shabbat (32a), which is accepted as halakha by the Shulḥan Arukh (Yoreh De’a 338:1) supports the telling of the truth to a terminally ill patient, in order for him to recite the confession. See subsection x, below.

   With regard to the opinions of the poskim of recent generations, some maintain that it is prohibited to reveal to a critically ill patient his true condition, and this is explicitly the stance taken in Iggerot Moshe, Ḥoshen Mishpat, II:73. However, Rabbi Feinstein was not dealing with this question directly in that responsum, and Rabbi Yigal Shafran (see below) contends that he was referring to a case where, in addition to informing the patient of his dire condition, the doctors also stop making any effort to help him. Giving such information is also prohibited by the author of the Betzel HaḤokhma (II:55), although he qualifies his ruling by noting that while we should hide the true severity of the illness from the patient he should not be misled into thinking that it is not serious. Rabbi Yitzchak Zilberstein (“Is it Permitted or Desirable to Disclose to a Patient his Critical Illness,” Emek Halakha, Assia 1, Jerusalem 1986, p. 163) maintains that silence and concealing the truth are preferable, except in those cases where we know for certain that this will not harm the patient. In contrast to them, Rabbi Y. Shafran (“Telling the Truth to a Patient Regarding his Condition,” Sefer Assia 7 (1994), pp. 23–30) writes that in most cases the patient must be told the truth, because it is his right, particularly when it comes to a critically ill patient who must confess and prepare himself for the World-to-Come, and especially in light of the fact that nowadays the truth cannot be concealed for any length of time. He adds by way of qualification that one must proceed with caution and examine each case on its own merits. Rabbi She’ar Yashuv Cohen (“The Obligations of a Doctor to a Terminally Ill Patient,” Torah SheBe’al Peh, 25 [1984] pp. 144–50) writes that nowadays the patient’s awareness of his illness can lower his level of fear and reduce his suffering, and therefore although he should not be told that there is no hope that he will live, the decision whether and what to disclose to him should be left to the discretion of the doctor and the family. See Encyclopedia of Medicine and Halakha, vol. 2, “Revealing information to the patient,” pp. 503–08; Nishmat Avraham, Yoreh De’a 338:4. For more sources, see the position paper, “Telling the Truth to a Patient Regarding his Medical Condition,” https://bit.ly/3tAWQb0.

   As we wrote in the previous footnote, the obligation to tell the truth must be the default position in any discussion. However, in certain cases it is possible, and even desirable, to refrain from doing so, as explained in the following subsections, and in footnotes 139–40 below.

5. The Shulḥan Arukh (Yoreh De’a 335:7) rules that one should instruct a critically ill patient to arrange his affairs before his death: “We tell him to set his mind on his affairs, if he loaned or deposited an article with someone, or if someone lent him or deposited an item with him, and he should not be afraid of death on that account.” See Rabbi S.Y. Cohen (previous footnote) who likewise writes that it is important to inform a patient about his condition so that he can arrange his personal affairs, such as a will and other arrangements pertaining to his family and property.
6. See chapter V, above.
7. See the following footnote, and chapter XIII above, subsections i-ii.
8. As explained in footnotes 134–35, telling the truth is a basic obligation. Accordingly, concealing or modifying the truth may be done only when it is in the patient’s interests and when the following conditions are met: (a) It is almost certain that the best medical course of action differs from that which he would choose were the decision up to him alone; (b) The patient is unable to make informed decisions; (c) The motive for departing from the truth is to preserve the patient’s dignity rather than any other goal (such as various considerations of family members).

   Furthermore, even when these conditions are met, the permission is qualified by several principles and limitations: (a) The patient has precedence over any other person in deciding whether and how he should be treated. Therefore, when it is assumed that the patient possesses reasonable judgment, the proper approach is to provide him with all the necessary information; (b) The use of the principle that one may depart from the truth in a case of necessity should be limited and applied judiciously. Generally, when permitted, one may refrain from telling the truth, but not tell an outright lie. When there is no other option, and it is in the best interest of the patient, one may even lie (see following footnote); (c) Even when a person is required to modify the truth or actually lie, it is important that he should not habituate himself to the practice. See Sukka 46b; Yevamot 63a, where amora’im express reservations with regard to lying even when it serves a purpose and does not harm anyone, in accordance with the verse: “They have taught their tongue to speak lies” (Jeremiah 9:4). See also the comments of Rabbeinu Yona in Sha’arei Teshuva, section 3, and in his Commentary to Avot, 1:18, where he writes that telling a lie, even when nobody is harmed, entails a severe punishment, since it accustoms one to falsehood.

9. The primary source that permits one to deviate from the truth is the Gemara in Yevamot (65b, alongside many other sources, as stated in footnote 134, above). The Gemara there does not refer explicitly to lying; rather, it states that “it is permitted for a person to depart from the truth in a matter that will bring peace.” The Ramban, in his Commentary on the Torah, on Genesis 18:13, explains that God’s statement to Abraham, in which He quotes Sarah as saying “shall I really bear a child, when I am old” (cited by the Gemara there as an example that God departs from the truth for the sake of peace) is in fact true; God merely refrained from revealing some of Sarah’s comments. The Arukh LaNer, in his commentary on that discussion, shows that each of the examples cited there involve ambiguous statements, rather than outright falsehoods. Although some of his interpretations are far-fetched, the resulting halakhic principle is that even when one must deviate from the truth, he should avoid an absolute lie. See the Taz, Yoreh De’a 402:8, who explains based on the Shulḥan Arukh (ibid., 12) that even though it is not necessary to inform a patient that a relative of his has died, it is prohibited to lie to him. However, according to the Ḥafetz Ḥayyim, Hilkhot Rekhilut, I:8, if it is not possible to modify the truth, it is even permitted to lie.
10. Shulḥan Arukh, Yoreh De’a 337:1 (see footnote 135, above). The wording of the baraita and the Shulḥan Arukh (together with his comments in 402:8; see previous footnote) implies that it is permitted merely to avoid telling him the truth, but later authorities maintain that if the patient asks about the deceased, it is even permitted to lie and say that he is alive (Kol Bo al Aveilut, p. 17). According to Rabbi S. Z. Auerbach, if one of the mourners has to visit the patient, he is even permitted to conceal his state of mourning by wearing normal shoes and an untorn garment. See Nishmat Avraham, Yoreh De’a 337:2.
11. This appears in the baraita in Shabbat (32a) and is cited in the Shulḥan Arukh (Yoreh De’a 338:1). However, it applies only to a patient whose end is near; if his death is not deemed to be imminent, greater weight is given to the concern that this proposal will upset him. This differentiation is cited by the Baḥ and the Shakh (ibid.). See the responsum of Nishmat Avraham, “The Terminally Ill Patient in Contrast to the Incurable Patient,” Assia 7 (1994), pp. 31–2. The halakha also requires one to soften the truth: “If someone is dying, we tell him ‘confess,’ and we add: ‘Many confessed and did not die, and many who did not confess, died; in reward for your confession you will live, and whoever confesses has a share in the World-to-Come’” (Shulḥan Arukh, ibid.). Those who favor the disclosure of medical information to a patient (Rabbi S.Y. Cohen and Rabbi Y. Shafran; see above) cite proof from this law regarding confession that whenever it is in the patient’s interests to be aware of his condition, we are obligated to inform him. See also Encyclopedia of Medicine and Halakha, vol. 2, “Revealing information to the patient,” pp. 502–03. With regard to the obligation to recite the confession nowadays, see our comments in the document: “Halakhot and Customs of the Time of Death,” on the Tzohar Ad 120 website (https://bit.ly/3mv2c3R). It also provides the text of the confession and other relevant prayers according to the various traditions, which can be recited before death and by others at the time of death.