UnitWarm-UpQuestionsIsitevenrighttotellalie?Doyoualwayswanttobetoldthetruth,nomatterhowunpleasant?Arethereanycircumstancesinwhichitisacceptableforadoctortotellalie?Isiteverproperforamedicaldoctortolietohispatient?Shouldhetellapatientheisdying?Thesequestionsseemsimpleenough,butitisnotsosimplytogiveasatisfactoryanswertothem.ToLieorNottoLie—Thedoctor’sDilemmaSisselaBokShoulddoctorseverlietobenefittheirpatients—tospeedrecoveryortoconcealtheapproachofdeath?Inmedicineasinlaw,government,andotherlinesofwork,therequirementsofhonestyoftenseemdwarfedbygreaterneeds;theneedtoshelterfrombrutalnewsortoupholdapromiseofsecrecy,toexposecorruptionortopromotethepublicinterest.Whatshoulddoctorsay,forexample,toa46-years-oldmancominginforaroutinephysicalcheckupjustbeforegoingonvacationwithhisfamilywho,thoughhefeelsinperfecthealth,isfoundtohaveaformofcancerthatwillcausehimtodiewithinsixmouths?Isitbesttotellhimthetruth?Ifheasks,shouldthedoctorsdenythatheisill,orminimizethegravityoftheillness?Shouldtheyatleastconcealthetruthuntilafterthefamilyvacation?Doctorsconfrontsuchchoicesoftenandurgently.Attimes,theyseeimportantreasontolieforthepatient’sownsake;intheireyes,suchliesdiffersharplyfromself-servingones.Studiesshowthatmostdoctorssincerelybelievethattheseriouslyilldonotwanttoknowthetruthabouttheircondition,andthatinformingthemrisksdestroyingtheirhope,sothatthemayrecovermoreslowly,ordeterioratefaster,perhapsevencommitsuicide.Asonephysicianwrote:"Oursisaprofessionwhichtraditionallyhasbeenguidedbyapreceptthattranscendsthevirtueofutteringthetruthfortruth’ssake,andthatisasfaraspossibledonoharm.”Armedwithsuchaprecept,anumberofdoctorsmayslipintodeceptivepracticesthatthattheyassumewill“donoharm”andmaywellhelptheirpatients.Theymayprescribeinnumerableplacebos,soundmoreencouragingthanthefactswarrant,anddistortgravenews,especiallytotheincurablyillandthedying.Buttheillusorynatureofthebenefitssuchdeceptionismeanttoproduceisnowconingtobedocumented.Studiesshowthat,contrarytothebeliefofmanyphysicians,anoverwhelmingmajorityofpatientsdowanttobetoldthetruth,evenaboutgraveillness,andfeelbetrayedwhentheylearnthattheyhavebeenmisled.Wearealsolearningthattruthfulinformation,humanelyconveyed,helpspatientscopewithillness;helpthemtoleratepainbetter,needlessmedicine,andevenrecoverfasteraftersurgery.Notonlydoliesnotprovidethe"help”hopedforbyadvocatesofbenevolentdeception;theyinvadetheautonomyofpatientsandrenderthemunabletomakeinformedchoicesconcerningtheirownhealth,includingthechoiceofwhethertobeapatientinthefirstplace.Wearebecomingincreasinglyawareofallthatcanbefallpatientsinthecourseoftheirillnesswheninformationisdeniedordistorted.Dyingpatientsespecially—whoareeasiesttomisleadandmostoftenkeptinthedark—canthannotmakedecisionsabouttheendoflife:aboutwhetherornottheyshouldenterahospital,orhavesurgery;aboutwhereandwithwhomtheyshouldspendtheirremainingtime;abouthowtheyshouldbringtheiraffairstoacloseandtakeleave.Liesalsodoharmtothosewhotellthem:harmtotheirintegrityand,inthelongrun,theircredibility.Lieshurttheircolleaguesaswell.Thesuspicionofdeceitundercutstheworkofthemanydoctorswhoarescrupulouslyhonestwiththeirpatients;itcontributestothespiraloflawsuitsandof“defensivemedicine,”andthusitinjures,inturn,theentiremedicalprofession.Sharpconflictsarenowarising.Patientsarelearningtopressforanswer.Patients’billofrightrequirethattheymaybeinformedabouttheirconditionandaboutalternativesfortreatment.Manydoctorsgotogreatlengthstoprovidesuchinformation.Yeteveninhospitalwiththemosteloquentbillofrights,believersinbenevolentdeceptioncontinuetheirage-oldpractices.Colleaguesmaydisapprovebutrefrainfromobjecting.Nursesmaybitterlyresenthavingtotakepart,dayafterday,indeceivingpatients,butfeelpowerlesstotakeastand.Thereisurgentneedtodebatethisissueopenly.Notonlyinmedicine,butinotherprofessionsaswell,practitionersmayfindthemselvesrepeatedlyindifficultywhereseriousconsequencesseemavoidableonlythroughdeception.Yetthepublichaseveryreasontobewaryofprofessionaldeception,forsuchpracticesarepeculiarlylikelytobecomedeeplyrooted,tospread,andtoerodetrust.Neitherinmedicine,norinlaw,government,orthesocialsciencescantherebecomfortintheoldsaying,“Whatyoudon’tknowcan’thurtyou.”[776words]譯文:醫生可也對病人撒謊嗎？醫生應該告訴病人他已經病入膏肓了嗎？這些問題看起來很簡單，但是要給出令人滿意的答案卻并不那么簡單。撒謊還是不撒謊一一醫生的難題西塞拉?博克為了對病人有好處一一為了加快病人康復或不讓病人知道死亡的來臨一一醫生該不該撒謊？醫療行業與法律、政府及其他行業一樣，往往顯得對誠實與否的問題不那么看重，要緊的倒是另外一些事情。譬如，應設法避免可怕的消息造成的打擊，或是應考慮恪守保密的諾言，或是需要揭露腐敗行為或促進公眾利益等。舉例說吧。一個46歲的男子，在與家人外出度假之前進行常規體格檢查。雖然他自我感覺良好，但醫生發現他患了某種癌癥，6個月內就會死去。這時，醫生該怎么對他講呢？是不是最好對他講實話？要是他問起檢查結果，醫生該不該否認他得了病？該不該將病情的嚴重性縮小到最低限度？該不該將真情至少隱瞞到全家度假之后？醫生常常面臨這樣的非常緊迫的選擇。他們不時認為，為了病人自身的利益，撒謊很有必要，在他們看來，這種謊言與利己的謊言截然不同。研究結果表明，大多數醫生深信身患重病的人不想知道他們的真實病情，如果將真情相告，則有可能使他們失去希望，結果使他們恢復得更慢或惡化的更快，甚至會自尋短見。正如一位內科醫生寫道：“我們這個職業，傳統上恪守一條信條，那就是：‘盡可能不造成傷害’，這一信條勝過為講真話而講真話的美德。”有了這樣一個指導原則，一些醫生可能漸漸習慣于采用他們認為對病人很可能有益而無害的騙人做法。他們可能開出無數貼安慰劑說一些沒有事實根據的打氣話，并歪曲嚴重的病情，對那些患者在不治之癥和瀕臨死亡的病人則尤其如此。然而現在有人提出證據，說明這種欺騙旨在給病人帶來好處的說法是虛幻的。研究結果表明，與許多醫生的想法相反，絕大多數病人確定想知道真實情況，甚至是嚴重的病情。當他們了解到醫生沒有對他們講真話的時候，他們感覺自己被玩弄了。我們還獲悉，將真實情況妥當的告訴病人，能幫助他們與病魔作斗爭，有助于他們跟好地忍受疼痛，減少用藥，甚至在手術后更快的康復。謊言不僅不能提供鼓吹“仁慈”欺騙的人們所希望的那種“幫助”他還侵犯了病人的個人自由，使他們不能對有關自己的健康的問題做出明達的選擇，包括要不要就醫這一首要的選擇。我們越來越意識到，病人發病期間，在不知病情或未被如實告知病情的情況下，他們會遭到什么樣的不幸。特別是瀕臨死亡的病人一一他們最容易受騙，也最會被人蒙在鼓里一一因此而不能做出臨終前的種種有關抉擇：是否要住進醫院或進行手術，在何處與何人度過所剩的一點點時間，以及如何處理完自己的事物而后與世長辭。謊言也傷害說謊的人，損害他們的誠實，并最終損害他們的信譽。謊言還傷害他們的同事，由于病人懷疑有欺騙行為。許多對病人十分開誠布公的醫生的工作也因此受到影響。病人的不信任使醫療訴訟案增多，造成醫生避免風險的“防御性診治”增多，而這些又進而有損整個醫療事業。劇烈的沖突還在出現。病人開始學會催問真實情況，根據病人應享有的權利