Truth-telling and Nonorganic Vision Loss

Ophthalmologists face an ethical dilemma when communicating with patients diagnosed with non-organic vision loss (NOVL) - should they reveal the findings of the exam and diagnosis of NOVL risking an angry breakdown in trust; or should they offer something more acceptable to the patient, avoiding discussion of psychiatry or suspicions of pretending? This dilemma reflects the ethical obligation of physicians to weigh the principle of respect for autonomy against the principle of beneficence. We conducted an international survey of neuro-ophthalmologists to examine professional perspectives regarding diagnosis and management of NOVL for adults and children with the goal of promoting discussion of the ethical implications for clinical practice.