Duties of Candour in Healthcare: The truth, the whole truth, and nothing but the truth?

The creation of professional and statutory duties of candour has formalised the requirement for clinicians and health care organisations to be honest with patients and families when treatment has gone wrong. This article explains the background to creating both duties, analyses the concept of candour and considers evidence about compliance. It argues that making candour a statutory requirement appropriately reflects the ethical imperative of telling the truth about harm and is a powerful signal for honesty. However, the call for candour arises in the context of complex professional cultures and the realities of delivering care in under funded health systems and a busy regulatory and medico-legal landscape. Proposals to create investigatory ‘safe spaces’ which prohibit disclosure, initially introduced in the Health Services Investigations Bill 2017, and which will re-appear in the forthcoming Health and Care Bill, undermine candour by withholding information from patients and families. This article argues against such proposals which are both wrong in principle and problematic in practice. Candour should be respected as a cardinal principle governing not only the conduct of those providing care, but also those who investigate such incidents.