Truth-Telling

Some shrewd old doctors have a few phrases always on hand for patients that will insist on knowing the pathology of their complaints without the slightest capacity of understanding the scientific explanation. I have known the term “spinal irritation” serve well on such occasions, but I think nothing on the whole has covered so much ground, and meant so little, and given such profound satisfaction to all parties, as the magnificent phrase “congestion of the portal system.” -Oliver Wendell Holmes, Medical Essays

This deception tortured him - their not wishing to admit what they all knew and what he knew, but wanting to lie to him concerning his terrible condition, and wishing and forcing him to participate in that lie. Those lies - lies enacted over him on the eve of his death and destined to degrade this awful, solemn act to the level of their visitings, their curtains, their sturgeon for dinner - were a terrible agony for Ivan Ilych.
-Leo Tolstoy, The Death of Ivan Ilych

Since we demand strict truthfulness from our patients, we jeopardize our whole authority if we let ourselves be caught by them in a departure from the truth. - Sigmund Freud, Collected Papers, II

(All of the above quotes were found in Bok, S. Lying Vintage Books (New York: 1989), pp. 220-221.)

Telling the truth is important because it:

  1. Respects others as rational decision-makers,
  2. Promotes trust.
  3. Is necessary for the development of human relations and thus society.
  4. Promotes truth and knowledge (e.g. scientific progress, education, etc.) which are necessary for improvements in the human condition.
  5. Is necessary for freedom.

While truth-telling usually promotes autonomy, it can conflict with autonomy when a patient does not want to be told the truth. The desire not to be told can be based on fear, anxiety, cultural belief, social expectations, denial, a desire to avoid responsibility, the belief that “it” doesn’t have power as long as it is not acknowledged, etc.

Placebo - This is where a patient is given a medicine or procedure which has no direct effect on the patient’s condition, yet may have powerful psychological effects leading to effective symptom relief. The effect is in part caused by the patient’s belief in the effectiveness of the medication or procedure. There are physiological bases for the placebo effect. Placebos can help patients with real ailments. Some patients can be trained to achieve this effect without the lie.

The exceptions above are all lies designed to benefit the patient. Is it ever acceptable to lie to benefit others?