Warm-up Questions

• Why do doctors want to tell lies to the dying?
• Is it common that doctors lie to the incurable patients? Why?
• Will you tell your father the truth if he has got a cancer? Why?
• Do patents have rights to know everything concerning their illnesses?

To Lie or Not to Lie?The Doctor’s Dilemma

Should doctors ever lie to benefit their patients?to speed recovery or to conceal the approach of death? In medicine as in law, government, and 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 promote the public interest..

What should doctors say, for example, to a 46?year?old man coming in for a routine physical 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 moths? 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 illness? Should they at least conceal the truth until after the family vacation?

Doctors confront such choices often and urgently. At times, they see important reasons to lie for the patient’s own sake; in their eyes, such lies differ from self-serving ones.

Studies show that most doctors sincerely 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 they recover more slowly, or deteriorate faster, perhaps even commit suicide. As one physician wrote: “Ours is a profession which traditionally has been guided by a precept that transcends the virtue of uttering the truth’s sake, and ‘as far as possible do no harm.’”

Armed with such a precept, a number of doctors may slip into deceptive practices that they assume will “do no harm” and they may well help their patients. They may prescribe 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 coming to be documented Studies show that, contrary to the belief of many 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: helps them tolerate pain better, need less medicine, and even recover faster after surgery.

Not only do lies 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 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 then not make decisions about the end of life: 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, to their credibility. 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 conflicts are now arising. Patients are learning to press for answers. Patients’ bills of rights require that they be informed about their condition and about alternatives for treatment. Many doctors go to great lengths to provide such information. Yet even in hospitals with the most eloquent bill of rights, 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. Not 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 don’t know can’t hurt you”.

NEW WORDS

dwarf[ dwC:f ]v.(使)矮小，相形见绌

corruption[ kE5rQpFEn ]n.腐败, 腐败行为

conceal[ kEn5si:l ]v.掩藏，掩盖

confront[ kEn5frQnt ]v．面对，面临

deteriorate[ di5tiEriEreit ]v.(使)蛮干；（使）变质

precept[ 5pri:sept ]n.（道德上的）箴言；戒律

transcend[ trAn5send ] vt.超越, 超过

virtue[ 5vE:tju: ]n. 美德, 优点,

prescribe[ pris5kraib ]v. 开(药)

warrant[ 5wCrEnt ]v.证明……为正当；保证,

incurably [in5kjuErEbl]adv.医治不好的; 无可救药的

illusory[I5lu:sErI]a.欺骗的；虚幻的,

overwhelming [ 7EuvE5welmiN ] a.势如破竹的，压倒性的,

render[ 5rendE ] v．报答，回报

distort[ dis5tC:t ]v.使变形, 扭曲,

integrity[ in5te^riti ]n. 诚实,

undercut [ 5QndEkQt ]v．索低价于竞争者

scrupulously [5skru:pjulEs] v.多顾虑的；　谨慎的,

alternative[ C:l5tE:nEtiv ] n.选择余地

eloquent[ 5elEkwEnt ]a.善辩的, 有口才的,

PHRASES

shelter from　遮掩，逃避　

for one’s sake　为了……利益

commit suicide自杀

be easiest to mislead最容易受误导

contribute to对……做贡献

in turn　　因此

be wary of 谨慎，提防

to great lengths不遗余力；想方设法

benevolent deception　撒仁慈之谎

NOTES

SisselaBok美国女作家，1934年出生于瑞典的斯德哥尔摩 : Lying: Moral choice in Public and Private Life; Secrets: On the Ethics of Concealment and Revelation; A Strategy for Peace: Human Values and the Threat of War; Alva Myrdal: A Daughter’s Memoir Defensive medicine

在美国，病人要是认为医生治疗不当，可以告至法庭，请求赔偿。由于赔偿巨大，因此医生就采用“防御性治疗”来避免受控告。　比如，做过多的检和治疗，主其他医生到场证实，　小病住院等。

What you don’t know　can’t hurt you.　

（英语俗语）“与基知道所有的事情，不如不知道，这样受的伤害　会少些。

这句话通常用来做不告诉某人某事的借口。

课文译文

实情与谎言＿＿医生的困惑

为加快病人的康复速度或遮掩死神降临的消息，　医生就该撒谎吗？在医学领域，就像在法律界、部门以及其它待业一样，出于更在的需要遮掩一个残酷消息的需要，或者遵守一个保密许诺的需要；揭露行为的需要，或者推进公众利益的需要诚实往往显得微不足道。

举个例子吧。一名46岁的男子在与家人一起度假之前，到医院做例行的身体检查。尽管他感觉自己身体很棒，但还是难事　查出患有某种癌症，六个月内可能丧命。这是，医生该对他说些什么呢？最好把实情告诉他吗？　要是他问起，　医生该对他的病情矢口否认，或者对其疾病的严重性轻描淡写吗？还是他们至少应该在他与家人度假归来再告知真情？

医生经常会遇到这样刻不容缓的抉择。有时，为了病人自身考虑，医生找出重要的理由来说谎。在他们看来，这样的谎言决无自私自利之目的。

研究表明，多数的医生真诚地相信：重病号不想得知疾病的实情，要是告知实情就会冒毁掉其希望的危险，导致其康复得更慢或者恶化得更快甚至自尽。正如一位医师所写的那样：“我们这个职业传统上一直受一个信箱支配：‘只要不造成伤害’，可以超越讲真话的美德来编造谎言。”

有了这样的信条撑腰，很多的医生会滑向欺骗的深渊，认为谎言不会“造成伤害”，只会帮助病人。他们会开出无数的安慰剂，说的话听起来比事实能说明的还令人鼓舞，并歪曲一些重大的消息，是对那些患有不治之症和要死的病人。

但是，这样的欺骗性谎言所带来的好处是虚幻的，其虚幻性正得到证实。恰恰与很多医师的观点相反，研究表明，绝大多数患　者确实希望被告知真实病情，哪怕病情严重。一量得知受到　欺骗，他们应有被出卖的感觉。我们还得知：富有人情味儿地传达给病人的真实消息会有助于病人妥善处理疾病帮助他们更好地忍受病痛，更少地服用药物，甚至手术后更快地康复。

谎言不仅仅带来了主张撒仁慈之谎的人所期望的“帮助”，还侵犯了病人的自主权，使他们不能就自身的健康善做出有据的选择。比如，首先得决定是否接受治疗。患者生病期间，真相被否认或者被歪曲时，我们会越来越多地意识到他们身上会发生的种种情况。

特别是那些要死的病人，最容易受误导，最常被蒙在鼓里，因而不能对生命的终结做出抉择：是否该进医院或做手术；在哪里以及与谁一道度过余生；应该如何结束人生事务，然后欣然离开。

谎言也会挫伤撒谎者本人：损害他们的诚实性，最终毁掉他们的信誉。谎言同样会伤害他们的同事：很多对病人小心翼翼、诚实坦率的医生因被怀疑有诈而声誉受损，从而引起诉讼案件和“防御性治疗”事件的上升。因此，谎言又伤害了整个医疗行业。

现在出现了强烈的冲突。病人学会去追根问底。各种的病人权利法案要求短短病人实情，让病人在治疗上做我把。很多医生想方设法提供这些信息。然而，即使在口口声声支持权利法案的医院里，撒仁慈之谎的信徒们还继续着他们那老掉牙的行径。对此，同事也许不加赞同，但却避免与其作对。护士们也许强烈怨恨不得不日复一日地参与　对病人撒谎，但在表明　立志上又感到无能为力。

现在，急需对此问题做出公开门诊。不仅在医学领域，在其它行业也一样，从业者会一再地陷入困惑之中：似乎只有通过谎言才能避免严重的后果。然而，公众却有充分的理由来提防职业性的欺骗行为，因为这样的行为特别容易变得根深蒂固，广泛传播，并腐蚀信任。不管在医学领域，还是在法律界、政府部门或者在社会科学方面，从下面这句古老的谚语中都　找不到慰藉的成分：“不知者不为其所害。”