The Ethics of Collusion and Nondisclosure in Cancer Care: A Perspective From Professional Psychology

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Many psychologists now work in hospitals providing behavioral health services to a diverse patient population with medical illnesses. In this unique work setting, a patient’s cultural health beliefs and practices might be in opposition to those of the clinician and can create ethical dilemmas. One culturally based ethical dilemma that might arise is collusion, which is the request by families to withhold health information from the patient. Collusion remains a common practice around the world, particularly in cultures where families play a large role in decision-making and patient care. Many patients and families who seek care in the United States come from such cultures. Although Western bioethics strongly favor disclosure, disregarding these requests outright can potentially disrupt the patient–clinician relationship. The purpose of this article is to review the literature discussing why collusion occurs and explore this ethical issue from the perspective of professional psychology using the American Psychological Association Ethical Principles of Psychologists and Code of Conduct.

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