Play along...

[tinyjo]

OK, just for fun, here is the essay question I will be answering this afternoon:

‘It is wrong to tell lies, so patients should always be told the truth about their condition.’ Is this a good argument?

I've turned off emailing comments on this and I promise not to look until I've written the essay (1000 words, in case you're interested). What do you think?

Comments

[yalovetz]

Whoah. Okay, so, yeah, there's a philosophy of language question in there for sure if we're talking about "truth".

First off, for this to be a good argument I'd expect it to be both logically sound and based on reasonable assumptions. Whether it's sound or not actually depends on what the assumptions are in this case, I think, and how you define the terms involved.

The first set of assumptions to tackle would be about what it means to lie, what it means to tell the truth, and whether not telling the truth is necessarily the same as lying. This is primarily a philosophy of language question.

The second assumption to tackle would be about whether lying (however it's defined) is wrong. This is primarily an ethical question and can only be dealt with once the philosophy of language question has been answered in some way or other.

I think I would actually be inclined to skip the second (ethical) question altogether and just argue that it's a bad argument because the conclusion doesn't logically follow from the proper definition of "lies" and "truth". But that's because I like arguing philosophy of language and dislike arguing ethics, so....

[oxfordhacker.livejournal.com]

I think I'd contrast this with the principle First do no harm (http://en.wikipedia.org/wiki/Primum_non_nocere), which wikipedia informs is not in fact from the Hippocratic Oath as I had thought, but is a fundamental of medical ethics. If the truth would be harmful, I'd say that could override the general principle that lying is wrong (and, indeed, the more specific principle that lying to your patient is wrong).

[badasstronaut.livejournal.com]

You'd wipe out a whole lot of potential placebo benefits if that was the case.

[zengineer.livejournal.com]

It's not an argument at all it is a statement with a corollary that does not follow since telling the truth is not the same as not telling lies. 1000 words?

[aveleh]

Maybe I've been out of school for too long, but this just doesn't seem like an *argument* to me, but rather two loosely related statements that don't actually follow each other.

I do think it's wrong to tell lies, but I don't think it always follows that one should tell the truth. Sometimes the wrong thing is the right thing.

And I'm pretty sure that some research has shown that some patients benefit from *not* being told the truth, specifically those who are certain stages of altzimers, where a true *feeling* environment is more important than a truthful one. And while I generally believe that a patient should be told the whole truth, it's because I believe that a doctor's job includes helping patients make informed decisions, not strictly because I believe it's wrong to lie.

So there's just something that doesn't sit right with me for this as an argument, and at least part of it is the *always*.

[prissi.livejournal.com]

lalalalalalala ethics & philosophy. I am terrible at all the rules and the defined this and that. So I shall simply weigh in on what I know! I will give you some examples where the second half of the statement isn't true-

1. The patient specifically asks that you do not tell him or his family the details of his condition. He may either wish to just receive treatment, or more commonly, to not receive treatment and just die in peace. At this point you can offer comfort care (i.e. pain meds, hospice, etc) if applicable and consented to by the patient. The patient should always be reassured that you will not abandon him.

2. The patient is a young child (or minor, really). In this case, the parents of the child decide what information that the patient gets to hear about their condition. While you should never ever lie to the patient (true), you are ethically required to respect the wishes of the parent in what the child can be told. If the child asks about their condition, we are taught to ask them, "What have your parents told you about your condition?" and go from there.

3. If the patient asks how long they have left to live, you are never to give them an actual time frame in months, even if your past experience suggests beyond all shadow of doubt that once a person has reached a certain point in a disease, they have exactly four months to live. You are to always give ranges, like, "At this stage in the disease, many patients usually have around half a year to live." Or "months to a year" or "a few years". The reason for this is obviously that there is always the possibility for some spontaneous miracle and you do not want people determining to "prove the doctor wrong" by "outliving" the exact time estimate given.

Those are just some things that came off the top of my head. I could also get into the "it is wrong to tell lies" part as it applies to medicine... like what I got asked at during my med school interview - "Say a kid needs a surgery NOW. If he doesn't get it, he'll live, but, he will never be able to walk or run again. Insurance won't approve it for another couple of weeks. But if you lie to the insurance company and say that he needs this surgery to save his life now, he will be able to walk and run again. What do you do?" and his follow up, "As you know, there are limited resources, what if this kid's surgery meant that 100 people could not get their medicine?" :P

[lady-angelina.livejournal.com]

Aside from what others have said, I don't think patients should be told the truth of their condition just because "it's wrong to lie" so much as it is that they have a right to know about anything that affects them. If a doctor withholds information from the patient, they could be preventing that patient the opportunity to research and educate themselves and their loved ones on their condition, and the opportunity to make whatever preparations as needed. Furthermore, deliberately misleading someone can lead to some very awkward moments (not to mention anger and distrust) later on if/when the person learns the truth, especially if it's through other means.

This, of course, mainly applies to people who can have a basic cognitive grasp on the situation. If it's a very young child, as Prissi said, and the child isn't yet at a point where they can understand the complexities of their condition, perhaps they can be given a modified but still true account of their condition. Kids are surprisingly savvier than we grown-ups tend to think; while we may not want to scare them or hurt their feelings, I think we do at least need to give them some credit. =/

Anyway, I'm sure none of this made sense, sorry. =/

[jinty]

There's also a distinction or a point to be made about the whole truth versus truthful statements. The original question implies the doctor would / should sit down and explain it all, including negative things which might impact on the patient's will to live (cf prissi's comment below) or otherwise not be helpful (cf brixtonbrood's comment about the placebo effect). You can say true things without telling the truth, if the latter is understood to mean "the whole truth".