INTRODUCTION

Health care professionals are currently trained and practice in an environment where personal health information is considered to belong to the patient, and where honesty and truth telling are considered virtues foundational to the therapeutic relationship. Professional codes of ethics and position statements define practitioners' responsibilities with regard to honesty and disclosure of information, although these concepts require interpretation and contextualization in clinical encounters with patients and families. Truth telling is considered especially important in relationships with children, whose vulnerability creates in us a special obligation to protect and who are in the process of having their character shaped – at least in part – by the adults with whom they interact.

The debate between those who support a consistent practice of telling the truth to children and those who believe this practice will cause them harm is not new. Pernick quotes Dr. Worthington Hooker, who in the 19th century argued that “[a] child can appreciate fair and honest treatment as well as an adult can, and he has as good a right to receive it.” Increasingly clear standards of practice in pediatrics are emerging. For example, the Canadian Paediatric Society holds that children