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1、Unit 5Warm-Up1. Is it even right to tell a lie?2. Do you always want to be told the truth, no matter how unpleasant?3. Are there any circumstances in which it is acceptable for a doctor to tell a lie?QuestionsIs it ever proper for a medical doctor to lie to his patient? Should he tell a patient he i
2、s dying? These questions seem simple enough, but it is not so simply to give a satisfactory answer to them.To Lie or Not to LieThe doctors DilemmaSissela BokShould doctors ever lie to benefit their patients to speed recovery or to conceal the approach of death? In medicine as in law, government, and
3、 other lines of work, the requirements of honesty often seem dwarfed by greater needs; the need to shelter from brutal news or to uphold a promise of secrecy, to expose corruption or to promote the public interest.What should doctor say, for example, to a 46-years-old man coming in for a routine phy
4、sical checkup just before going on vacation with his family who, though he feels in perfect health, is found to have a form of cancer that will cause him to die within six mouths? Is it best to tell him the truth? If he asks, should the doctors deny that he is ill, or minimize the gravity of the ill
5、ness? Should they at least conceal the truth until after the family vacation?Doctors confront such choices often and urgently. At times, they see important reason to lie for the patients own sake; in their eyes, such lies differ sharply from self-serving ones.Studies show that most doctors sincerely
6、 believe that the seriously ill do not want to know the truth about their condition, and that informing them risks destroying their hope, so that the may recover more slowly, or deteriorate faster, perhaps even commit suicide. As one physician wrote: “Ours is a profession which traditionally has bee
7、n guided by a precept that transcends the virtue of uttering the truth for truths sake, and that is as far as possible do no harm.”Armed with such a precept, a number of doctors may slip into deceptive practices that that they assume will “do no harm” and may well help their patients. They may presc
8、ribe innumerable placebos, sound more encouraging than the facts warrant, and distort grave news, especially to the incurably ill and the dying.But the illusory nature of the benefits such deception is meant to produce is now coning to be documented. Studies show that, contrary to the belief of many
9、 physicians, an overwhelming majority of patients do want to be told the truth, even about grave illness, and feel betrayed when they learn that they have been misled. We are also learning that truthful information, humanely conveyed, helps patients cope with illness; help them tolerate pain better,
10、 need less medicine, and even recover faster after surgery.Not only do lies not provide the “help” hoped for by advocates of benevolent deception; they invade the autonomy of patients and render them unable to make informed choices concerning their own health, including the choice of whether to be a
11、 patient in the first place. We are becoming increasingly aware of all that can befall patients in the course of their illness when information is denied or distorted.Dying patients especially who are easiest to mislead and most often kept in the dark can than not make decisions about the end of lif
12、e: about whether or not they should enter a hospital, or have surgery; about where and with whom they should spend their remaining time; about how they should bring their affairs to a close and take leave.Lies also do harm to those who tell them: harm to their integrity and, in the long run, their c
13、redibility. Lies hurt their colleagues as well. The suspicion of deceit undercuts the work of the many doctors who are scrupulously honest with their patients; it contributes to the spiral of lawsuits and of “defensive medicine,” and thus it injures, in turn, the entire medical profession.Sharp conf
14、licts are now arising. Patients are learning to press for answer. Patients bill of right require that they may be informed about their condition and about alternatives for treatment. Many doctors go to great lengths to provide such information. Yet even in hospital with the most eloquent bill of rig
15、hts, believers in benevolent deception continue their age-old practices. Colleagues may disapprove but refrain from objecting. Nurses may bitterly resent having to take part, day after day, in deceiving patients, but feel powerless to take a stand.There is urgent need to debate this issue openly. No
16、t only in medicine, but in other professions as well, practitioners may find themselves repeatedly in difficulty where serious consequences seem avoidable only through deception. Yet the public has every reason to be wary of professional deception, for such practices are peculiarly likely to become deeply rooted, to spread, and to erode trust. Neither in medicine, nor in law, government, or the social sciences can there be comfort in the old saying, “What you dont know cant hurt yo
