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正在进行安全检测...

发布时间：2023-12-05 06:14:00 来源：文档文库

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Unit5TOLIEORNOTTOLIE—THEDOCTOR'SDILEMMASisselaBokIsiteverproperforamedicaldoctortolietohispatient?Shouldhetellapatientheisdying?Thesequestionsseemsimpleenough,butitisnotsosimpletogiveasatisfactoryanswertothem.Nowanewlightisshedonthem.
Shoulddoctorseverlietobenefittheirpatients--tospeedrecoveryortoconcealtheapproachofdeath?Inmedicineasinlaw,government,andotherlinesofwork,therequirementsofhonestyoftenseemdwarfedbygreaterneeds:theneedtoshelterfrombrutalnewsortoupholdapromiseofsecrecy;toexposecorruptionortopromotethepublicinterest.Whatshoulddoctorssay,forexample,toa46-year-oldmancominginforaroutinephysicalcheckupjustbeforegoingonvacationwithhisfamilywho,thoughhefeelsinperfecthealth,isfoundtohaveaformofcancerthatwillcausehimtodiewithinsixmonths?Isitbesttotellhimthetruth?Ifheasks,shouldthedoctorsdenythatheisill,orminimizethegravityoftheillness?Shouldtheyatleastconcealthetruthuntilafterthefamilyvacation?Doctorsconfrontsuchchoicesoftenandurgently.Attimes,theyseeimportantreasonstolieforthepatient'sownsake;intheireyes,suchliesdiffersharplyfromself-servingones.Studiesshowthatmostdoctorssincerelybelievethattheseriouslyilldonotwanttoknowthetruthabouttheircondition,andthatinformingthemrisksdestroyingtheirhope,sothattheymayrecovermoreslowly,ordeterioratefaster,perhapsevencommitsuicide.Asonephysicianwrote:"Oursisaprofessionwhichtraditionallyhasbeenguidedbyapreceptthattranscendsthevirtueofutteringthetruthfortruth'ssake,andthatis'asfaraspossibledonoharm.'"Armedwithsuchaprecept,anumberofdoctorsmayslipintodeceptivepracticesthattheyassumewill"donoharm"andmaywellhelptheirpatients.Theymayprescribeinnumerableplacebos,soundmoreencouragingthanthefactswarrant,anddistortgravenews,especiallytotheincurablyillandthedying.Buttheillusorynatureofthebenefitssuchdeceptionismeanttoproduceisnowcomingtobedocumented.Studiesshowthat,contrarytothebeliefofmanyphysicians,anoverwhelmingmajorityofpatientsdowanttobetoldthetruth,evenaboutgraveillness,andfeelbetrayedwhentheylearnthattheyhavebeenmisled.Wearealsolearningthattruthfulinformation,humanelyconveyed,helpspatientscopewithillness:只供学习与交流

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helpsthemtoleratepainbetter,needlessmedicine,andevenrecoverfasteraftersurgery.Notonlydoliesnotprovidethe"help"hopedforbyadvocatesofbenevolentdeception;theyinvadetheautonomyofpatientsandrenderthemunabletomakeinformedchoicesconcerningtheirownhealth,includingthechoiceofwhethertobepatientinthefirstplace.Wearebecomingincreasinglyawareofallthatcanbefallpatientsinthecourseoftheirillnesswheninformationisdeniedordistorted.Dyingpatientsespecially--whoareeasiestomisleadandmostoftenkeptinthedark--canthennotmakedecisionsabouttheendoflife:aboutwhetherornottheyshouldenterahospital,orhavesurgery;aboutwhereandwithwhomtheyshouldspendtheirremainingtime;abouthowtheyshouldbringtheiraffairstoacloseandtakeleave.Liesalsodoharmtothosewhotellthem:harmtotheirintegrityand,inthelongrun,totheircredibility.Lieshurttheircolleaguesaswell.Thesuspicionofdeceitundercutstheworkofthemanydoctorswhoarescrupulouslyhoneswiththeirpatients;itcontributestothespiraloflawsuitsandof"defensivemedicine,"andthusitinjures,inturn,theentiremedicalprofession.
Sharpconflictsarenowarising.Patientsarelearningtopressforanswers.Patients'billsofrightsrequirethattheybeinformedabouttheirconditionandaboutalternativesfortreatment.Manydoctorsgotogreatlengthstoprovidesuchinformation.Yeteveninhospitalswiththemosteloquentbillofrights,believersinbenevolentdeceptioncontinuetheirage-oldpractices.Colleaguesmaydisapprovebutrefrainfromobjecting.Nursesmaybitterlyresenthavingtotakepart,dayafterday,indeceivingpatients,butfeelpowerlesstotakeastand.
Thereisurgentneedtodebatethisissueopenly.Notonlyinmedicine,butinotherprofessionsaswell,practitionersmayfindthemselvesrepeatedlyindifficultywhereseriousconsequencesseemavoidableonlythroughdeception.Yetthepublichaseveryreasontobewaryofprofessionaldeception,forsuchpracticesarepeculiarlylikelytobecomedeeplyrooted,tospread,andtoerodetrust.Neitherinmedicine,norinlaw,government,orthesocialsciencescantherebecomfortintheoldsaying,"Whatyoudon'tknowcan'thurtyou."

撒谎还是不撒谎——医生的难题
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