说谎还是不说谎医生的难题

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]译文:医生可也对病人撒谎吗？医生应该告诉病人他已经病入膏肓了吗？这些问题看起来很简单，但是要给出令人满意的答案却并不那么简单。撒谎还是不撒谎一一医生的难题西塞拉•博克为了对病人有好处一一为了加快病人康复或不让病人知道死亡的来临一一医生该不该撒谎？医疗行业与法律、政府及其他行业一样，往往显得对诚实与否的问题不那么看重，要紧的倒是另外一些事情。譬如，应设法避免可怕的消息造成的打击，或是应考虑恪守保密的诺言，或是需要揭露腐败行为或促进公众利益等。举例说吧。一个46岁的男子，在与家人外出度假之前进行常规体格检查。虽然他自我感觉良好，但医生发现他患了某种癌症，6个月内就会死去。这时，医生该怎么对他讲呢？是不是最好对他讲实话？要是他问起检查结果，医生该不该否认他得了病？该不该将病情的严重性缩小到最低限度？该不该将真情至少隐瞒到全家度假之后？医生常常面临这样的非常紧迫的选择。他们不时认为，为了病人自身的利益，撒谎很有必要，在他们看来，这种谎言与利己的谎言截然不同。研究结果表明，大多数医生深信身患重病的人不想知道他们的真实病情，如果将真情相告，则有可能使他们失去希望，结果使他们恢复得更慢或恶化的更快，甚至会自寻短见。正如一位内科医生写道：“我们这个职业，传统上恪守一条信条，那就是：‘尽可能不造成伤害’，这一信条胜过为讲真话而讲真话的美德。”有了这样一个指导原则，一些医生可能渐渐习惯于采用他们认为对病人很可能有益而无害的骗人做法。他们可能开出无数贴安慰剂说一些没有事实根据的打气话，并歪曲严重的病情，对那些患者在不治之症和濒临死亡的病人则尤其如此。然而现在有人提出证据，说明这种欺骗旨在给病人带来好处的说法是虚幻的。研究结果表明，与许多医生的想法相反，绝大多数病人确定想知道真实情况，甚至是严重的病情。当他们了解到医生没有对他们讲真话的时候，他们感觉自己被玩弄了。我们还获悉，将真实情况妥当的告诉病人，能帮助他们与病魔作斗争，有助于他们跟好地忍受疼痛，减少用药，甚至在手术后更快的康复。谎言不仅不能提供鼓吹“仁慈”欺骗的人们所希望的那种“帮助”他还侵犯了病人的个人自由，使他们不能对有关自己的健康的问题做出明达的选择，包括要不要就医这一首要的选择。我们越来越意识到，病人发病期间，在不知病情或未被如实告知病情的情况下，他们会遭到什么样的不幸。特别是濒临死亡的病人一一他们最容易受骗，也最会被人蒙在鼓里一一因此而不能做出临终前的种种有关抉择：是否要住进医院或进行手术，在何处与何人度过所剩的一点点时间，以及如何处理完自己的事物而后与世长辞。谎言也伤害说谎的人，损害他们的诚实，并最终损害他们的信誉。谎言还伤害他们的同事，由于病人怀疑有欺骗行为。许多对病人十分开诚布公的医生的工作也因此受到影响。病人的不信任使医疗诉讼案增多，造成医生避免风险的“防御性诊治”增多，而这些又进而有损整个医疗事业。剧烈的冲突还在出现。病人开始学会催问真实情况，根据病人应享有的权利