In this paper I make a radical claim regarding selective non-disclosure of treatment options that have some hope of prolonging a patient's life. I suggest that selective non-disclosure under such circumstances is tantamount to what might be called “euthanasia by deception.” I offer a case to test the validity of my claim and to demonstrate how the failure to offer or, at least, to discuss renal dialysis in this case (and, by inference, any other form of treatment which has some (...) hope of prolonging a patient's life) qualifies as paternalism in its most egregious form. I discuss the actions of the health care team and try to find some plausible reasons why they acted as they did. I conclude that there must be greater emphasis placed on teaching clinicians how better to incorporate frank, open and on-going discussion about the central elements of the therapeutic relationship with patients long before they lose decisional capacity. (shrink)