[dekhn]

This is a "why don't you just" answer. The reason the establishment does this is that we know the outcome of telling people is worse than not telling them. This is an expensive lesson learned over over a century of medical treatment.

[delichon]

Outside of an emergency I would prefer "first, fully inform" to "first, do no harm", acknowledging the potentially mortal cost.

[dekhn]

What if you had stats that showed that (the fully inform) policy produced more negative results?

Would you insist on fully informing if the outcome was, on average, worse? If so, why?

[delichon]

Yes, because I have met many doctors whose judgement I profoundly mistrust, and prefer my own. Sometimes their whole paradigm is flawed, but sometimes they're just not informed about my own values. And I would rather die by my own misjudgment than theirs.

[dekhn]

OK good luck when you get real sick! Because that's what you'll be depending on.

[delichon]

I'm an old guy, it's happened several times. The last time, a surgeon removed a tumor, found that it was malignant ... and then told me that it was no big deal, it was a kind of cancer that would not have caused serious problems. She said if she had to get cancer she'd pick this kind. I wish she had told me that before the surgery. I may have had it anyway, but maybe not. Wouldn't you value being fully informed more after that? Surgeons have as much of a conflict of interest when selling their own services as anyone else.

[dekhn]

I'm not sure what your point is. This discussion is about medical researchers making decisions on thousands or millions of patients in aggregate... what you're describing is a common thing (don't know how bad a tumor is until it's removed).

The doctor didn't know that before removing the tumor (almost certainly; the alternative is medical fraud).

[reverius42]

Also, if the outcome is worse by informing, doesn't that imply a violation of "first, do no harm"? Which, to be fair, the OP says they wouldn't prioritize...

[dekhn]

Depends on how you interpret: "First do no harm". Is that an obligation to minimize the harm to an individual patient? Or is the goal to maximize the health of many patients? Like I've said elsewhere, medical reasoning is subtle.