Family requests to withhold a serious diagnosis from a patient are frequently framed as expressions of protection, filial care, and responsibility. In settings influenced by Confucian family ethics, these requests can acquire additional moral force because illness is experienced through relationships of dependence, reciprocity, and obligation. Yet the ethical significance of family responsibility does not by itself determine who should control a competent patient’s access to clinically important information. This comparative normative analysis examines how truth disclosure, filial responsibility, patient preferences, and family authority should be related when families ask clinicians to conceal serious diagnoses. Using comparative and translational normative reasoning, it distinguishes the moral importance of family care from authority over information, and examines when relational involvement supports rather than displaces patient agency. The analysis argues that filial responsibility can justify accompaniment, preparation, emotional protection, culturally responsive pacing, and patient-authorized mediation. These functions become ethically problematic when protective responsibility is transformed into an independent family entitlement to prevent a decision-capable patient from receiving information that the patient wishes to know. A Confucian-informed approach can therefore preserve meaningful family participation without treating compulsory silence as the default expression of filial care. The resulting position is conditional: ethically justified disclosure should remain responsive to the patient’s own informational preferences, including preferences for staged communication, limited information, or voluntary delegation to trusted relatives.
