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Lying in emergencies

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DMR

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In a course on first aid I once took, my teacher strongly advocated lying to injured victims in an emergency. He said that one's chance of survival was strongly tied to one's hope and confidence that he will survive. Therefore, no matter how awful the victim looks, or how likely you think they are are to die, you should assure them that they will be fine, that their injuries are minor, and so on. Is this unethical?

My current position: it isn't. Lying is unethical only insofar as it is an act of communication. In this case, lying is a therapeutic act. Or, equivalently, the victim of a serious injury is incapable of being rational, so in a sense you cannot lie to them, in the same way you cannot lie to a dog (you can mislead or confuse a dog, such as by giving him a piece of styrofoam shaped like a bone, but this is not a lie). When you are seriously injured you begin to act quasi-instinctively, and so the standards of interaction designed for rational beings no longer apply.

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This is a very interesting question.

My first reaction was to simply say: "Okay if you lie to them their chance of survival increases."

Simple decision.

On the other hand this encourages an attitude that "I know better than you do what is good for you," which is immoral, as well as the kind of thinking that encourages big government.

My second reaction was to say: "Everyone should have the right to make their own autonomous decisions, and have no one else secretly making decision for them."

So you should tell them.

Now my third reaction is to say: "Okay, this is first aid. On a purely physical level we expect the provider of first aid to do things for wounds and so on without consulting the patient, and asking for their input. The first aid provider does what is necessary to promote the survival of the patient. If it is necessary to lie to them, then that is fitting with the other medical help they provide."

So lying would seem legitimate within the context of the emergency situation.

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In a course on first aid I once took, my teacher strongly advocated lying to injured victims in an emergency.

In my EMT class, what was stressed was calming the patient/victim down, assure them that they are now in good hands, and that you will do everything you can to get them to the hospital, where the best possible care can be given to them. Most of the time, EMT's or Paramedics give oxygen to a patient as well, which comes from a mask. They aren't as talkative or asking questions like, "Am I going to make it?" when that thingy's on them. You can even say, "It's going to be okay, we're going to get you to the hospital..." Or making them answer your questions, instead of allowing them time to ask theirs...at least curbing the ones like the above question. Situations vary obviously...it's best to be taught by instructors that have actually been on the trucks, at the stations, etc. I don't know if your teacher has experience, or what class you are in...but that's how I was being taught, basically. There are specific sections in EMT-training books directed towards this, but I don't remember mine "strongly" advocating lying...

Here's another I just thought of...

"Am I going to make it, am I going to live?" victim asks, right before I put an oxygen mask on...

"You're living through it right now..." i'd say, while putting the mask on her or him...

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Lying to the patient like that is wrong in the same way it is for a doctor to lie to a patient. The patient has the same rights regarding first aid as they do involving medical treatment, i.e., the right to refuse treatment, which presupposes the right to knowing what is being done to them, what has happened to them, and what their chances of recovery are. I was taught in first aid classes that it is unethical to lie to patients for that reason and I agree with them. Besides, lying is not necessary to calm them. It is quite possible to calm them without lying. Unless they become extremekky irrational, but that does not justify you lying to them, as they still have a right to the truth regarding their bodies.

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I think you should be honest with the person. If his chances of survival are good, then tell him that. Let him adjust to the idea that he will make it. But if his chances are not good, then you should tell him the truth. If someone lied to me and told me I would be okay but I really wouldn't, I'd never get to say the things and do the things I might have the last chance to say and do.

Edited by Mimpy
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Here is a good and relevant post from the thread SoftwareNerd linked to:

Respect for the dying can rightfully entail such things as not making accusations (it won't accomplish anything), but the fact that someone is dying does not entitle them to have reality rearranged to satisfy their whims. What kind of respect for a human being is THAT?!

I would agree with that and would say that the fact that the patient is injured does not give the pateint entitlement to have reality rearranged to satisfy their whims. Lying to them in the way you suggest is merely a form of whim-worshipping. You are worshipping their desire to have reality rearranged to their whims, which you should never do. As JMeganShow says, that is no respect for the human being, especially the patient that wants the truth from you instead of your lies.

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I think it is not only fine, but morally obligatory for doctors to lie to patients in emergencies if doing so increases the patients' chance of survival.

Lying is normally wrong because it does damage to one's ability to deal with reality, but in a life-or-death emergency situation, lying is a medical measure that recognizes the fact that the stress of knowing the truth could kill someone (the patient should be told the truth once the crisis is over).

Incidentally, doesn't Ayn Rand say something on this subject in Ayn Rand Answers?

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I think it is not only fine, but morally obligatory for doctors to lie to patients in emergencies if doing so increases the patients' chance of survival.

Lying is normally wrong because it does damage to one's ability to deal with reality, but in a life-or-death emergency situation, lying is a medical measure that recognizes the fact that the stress of knowing the truth could kill someone (the patient should be told the truth once the crisis is over).

What if the patient wants to know the truth? As I have already said, they have a right to know what is happening to them.

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He said that one's chance of survival was strongly tied to one's hope and confidence that he will survive.

If true, I would like to see the evidence for it.

I can see how one's positive attitude can play more of a role when it comes to fighting an illness such as cancer - something which is strongly tied to the state of our immune system which can be affected by our psychology but during emergencies, having been considerably wounded?

I personally would not want to be lied to. At any point in my life including while dying I want to stay commited to what is real. I want my ability to deal with reality be respected.

Edited by ~Sophia~
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What if the patient wants to know the truth?

I think the doctor's primary obligation is to save the person's life, not necessarily be honest to them if he honestly thinks doing so would be a detriment to the primary goal.

I'm inclined to want to live over wanting the truth in such a medical emergency IF it would really make a difference. I'll deal with being lied to later while I'm still living.

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I think the doctor's primary obligation is to save the person's life, not necessarily be honest to them if he honestly thinks doing so would be a detriment to the primary goal.

No, the doctor only as an obligation to save a patient if he wants to live. If he does not the doctor has no obligation. It is the patient's right to decide if he will live or die and that can only rationally be done if he is told the truth, therefore the doctor has an obligation to tell the patient the truth.

I'm inclined to want to live over wanting the truth in such a medical emergency IF it would really make a difference. I'll deal with being lied to later while I'm still living.

What about both? To me both the truth and living is preferable over one or the other. There is no reason why both cannot occur.

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Keeping the context, emergencies, I agree that it is not immoral to lie to a person about their prospects if it is reasonable that keeping hope alive will help keep the patient alive. Your purpose it to help the person survive the trauma, and if you tell them "50% of victims die", that could very easily cause those mind/body interactions where a person just freaks out (remember, emotions are physical reactions, which might actually kill you). It's pointless to say that it's irrational to fear dying when there is a 50% chance of surviving.

That said, lying is okay only when the truth kills. If the patient is irrevocably dying and is psychologically in the place where he can handle the truth without his last minutes on Earth be agony, truth is called for.

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I would say that in most cases, the doctor should be entirely honest with the patient, for the reasons say DragonMaci gives.

However, if the doctor beleives that telling the truth will in some way hazard the patients life (assuming that this could be and is the case), and if his primary goal is to save the patients life, then a lie might be justified if it saves the patients life. I would much rather be alive and have to deal with being alive, than dead..and well nothing.

But otherwise, I would say yes, full truth.

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Keeping the context, emergencies, I agree that it is not immoral to lie to a person about their prospects if it is reasonable that keeping hope alive will help keep the patient alive.

A lie would only make a difference to an irrational person, not a rational person. So in lying you are catering top their irrationality. You should never cater to their irrationality like that, regardless of the fact that it might save their lives, which i am highly sceptical about. In very few situations would it make much a difference if it made any at all.

Your purpose it to help the person survive the trauma, and if you tell them "50% of victims die", that could very easily cause those mind/body interactions where a person just freaks out (remember, emotions are physical reactions, which might actually kill you). It's pointless to say that it's irrational to fear dying when there is a 50% chance of surviving.

There are others ways to do that than lying, such as soothing them. In fact soothing them is almost always more efficient.

Besides, as I said the patient has the right to know the truth because without it he cannot make rational decisions about whether or not to accept treatment, which he has the right to refuse.

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However, if the doctor beleives that telling the truth will in some way hazard the patients life (assuming that this could be and is the case), and if his primary goal is to save the patients life, then a lie might be justified if it saves the patients life.

I doubt that the truth could ever be a hazard if the person was rational. Besides, what about the refusal of treatment right? Lying breaches that as it makes them unable to rationaly make that decision. That right is the most importsant factor in this debate. And we should not cater to irrationality, even to save the life of the irrational.

I would much rather be alive and have to deal with being alive, than dead..and well nothing.

As I said already, what about both? There is absolutely no reason why it is not possible to do both.

I think it is always wrong to lie to a patient because it breaches the right to refusal of treatment and because there is always a superior alternative.

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I think the remarks about "whim-worshipping" and "false reality" ignore the data that would indicate that the patient's beliefs and state-of-mind do have an effect on their probability of survival.

I think the issue is that telling them they are fine makes it more likely that they will pull through, all other things being equal. Telling them they are not fine lowers the chances of pulling through.

The remarks about "whim-worshipping" assume that patient survival is totally independent of the patient's state of mind.

In cases like this, as I understand things, the patient's whims do in fact effect the outcome.

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I think the remarks about "whim-worshipping" and "false reality" ignore the data that would indicate that the patient's beliefs and state-of-mind do have an effect on their probability of survival.

I think the issue is that telling them they are fine makes it more likely that they will pull through, all other things being equal. Telling them they are not fine lowers the chances of pulling through.

But what if the patient does not want treatment or to survive? The patient has the right to make that decision. They need the truth if they are to make an informed and rational decision on that!

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I doubt that the truth could ever be a hazard if the person was rational. Besides, what about the refusal of treatment right? Lying breaches that as it makes them unable to rationaly make that decision. That right is the most importsant factor in this debate. And we should not cater to irrationality, even to save the life of the irrational.

As I said already, what about both? There is absolutely no reason why it is not possible to do both.

I think it is always wrong to lie to a patient because it breaches the right to refusal of treatment and because there is always a superior alternative.

Thats the thing, not everyone is ever going to be rationa all the time especially when they are seriously injured or ill. There is a good case for the doctor choosing to lie to the patient if he beleives the alternative is the patients most likely death. I think we can all see which is the best alternative and why this is so.

Lying to prevent a treatment right as you put it, probably woudlnt be justified. But let me try to give an example where lying to him in another case might be:

The patient has some disease, lets call it Illness A. Illness A is treatable by one known method, however the treatment contains a chemical the patient is against taking for some stupid reason (even to the point of death), and the doctor is convinced he will not be able to talk the patient out of his irrational beleif Now the doctor has the choice of allowing the patients paranoia, condemning himself to death , or lyhing to him and saying it deosnt contain the substance if the patient asks and having the patient at least be alive.

Such cases seem far fetched, but I have heard of such happening

Now a case that might apply to a more rational person. This time the treatment is considered based on the results of faulty experiments. The patient has accepted this data, not knowing the so called proof is wrong, its not a matter of irrationality, to his best judgement and knowledge, the experiments are correct. so he beleives and without being irrational that it is indicated the drugs are dangerous and will cause a worth death most likely than the illness.

Now the doctor however has objective proof that the experiments are wrong, it doesnt cause any significant harm, and should save the patients life. Now he doesnt have time to convince the patient that he is right, the proof is long and complicated, and he doesnt expect the patient will beleive his mere claims, as the patient beleives that he has proof that the treatment will kill him, and he deosnt want to die a worse death. So the doctor can lie, and say the treatment is something else, and save the patient, or he can let the patient die...he hasnt time to honestly get the patient to take the treatment knowing what is ...even though the guy is rational and acting to thie best of what he beleives to be true.

Why is there ALWAYS an superior alternative?

Sometimes it is a matter of letting a patients irratioanl decisions kill them versus lying...I think the first is much worse than the latter. And you cannot say this never happens. And there are other cases involving even more rational people. So your "always" claim is false.

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Thats the thing, not everyone is ever going to be rationa all the time especially when they are seriously injured or ill.

I am well aware of that, but as I said several times already, we should not cater to the irrational. There is never justification for catering to the irrational.

There is a good case for the doctor choosing to lie to the patient if he beleives the alternative is the patients most likely death. I think we can all see which is the best alternative and why this is so.

Translationh: There is a good case for the doctor to make it so the patient cannot make the decision on whether to live or die on reality, to make it so the decision id based on fantasy instead. Whether you intended it or not, that is the meaning of what you said. The patient always has a right to know the truth in any case.

Lying to prevent a treatment right as you put it, probably woudlnt be justified.

Well, whether you intend it or not, that is what the lie always ends up as.

The patient has some disease, lets call it Illness A. Illness A is treatable by one known method, however the treatment contains a chemical the patient is against taking for some stupid reason (even to the point of death), and the doctor is convinced he will not be able to talk the patient out of his irrational beleif Now the doctor has the choice of allowing the patients paranoia, condemning himself to death , or lyhing to him and saying it deosnt contain the substance if the patient asks and having the patient at least be alive.

That lie still breaches the patient's right to know what is being done to him. There is no justification to deny the patient the right to know what is being done to him and there can be done.

Now a case that might apply to a more rational person. This time the treatment is considered based on the results of faulty experiments. The patient has accepted this data, not knowing the so called proof is wrong, its not a matter of irrationality, to his best judgement and knowledge, the experiments are correct. so he beleives and without being irrational that it is indicated the drugs are dangerous and will cause a worth death most likely than the illness.

Now the doctor however has objective proof that the experiments are wrong, it doesnt cause any significant harm, and should save the patients life. Now he doesnt have time to convince the patient that he is right, the proof is long and complicated, and he doesnt expect the patient will beleive his mere claims, as the patient beleives that he has proof that the treatment will kill him, and he deosnt want to die a worse death. So the doctor can lie, and say the treatment is something else, and save the patient, or he can let the patient die...he hasnt time to honestly get the patient to take the treatment knowing what is ...even though the guy is rational and acting to thie best of what he beleives to be true.

Again the patient's right to know what is being done to him.

Why is there ALWAYS an superior alternative?

Because regardless of intent, lying to the patient always results in breaching his right to know what is being done to him.

Sometimes it is a matter of letting a patients irratioanl decisions kill them versus lying...I think the first is much worse than the latter. And you cannot say this never happens. And there are other cases involving even more rational people. So your "always" claim is false.

If the patient dies, even because it is of a irrational decision, it is of their choice and no one has the right to countermand that choice under any circumstances.

And thus I have just illustrated how my "always" claim is not false. because there is never justification for countermanding the patient's decision to die and nev er justification for breaching the patients right to know what is being done to them.

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I am well aware of that, but as I said several times already, we should not cater to the irrational.

So a doctor should allow a patient, whom for all he knows is usually rational to die? What if he knows the guy is normally very ratonal, but is succumbing to irrationality due to the severe stress of severe illness / injury? Should he apply this e ven then and let him die? If we take what you say literally, and what other way should we take it: YES. I strongly disagree with that.

Translationh: There is a good case for the doctor to make it so the patient cannot make the decision on whether to live or die on reality, to make it so the decision id based on fantasy instead. Whether you intended it or not, that is the meaning of what you said. The patient always has a right to know the truth in any case.

That is not a valid translatioin, and not what I said. Sure, it might voilate his rights, but is it better to DIE than to have your rights violated even if so? Should the doctor beleive the patient would prefer DEATH over having his rights violated? I dont think so, most sane people would rather be lied to have their rights violated than to die. This is an emergency situation, moral issues like these are absolutes never to be breached, in non-emergency situations. But in matters of life and death, it is sometimes better to commit what would normally be immoral than allow yourself to die or others to die.

If you refuse to understand this, then that is your problem, and I will not debate it. Go read up on things a bit more before you try to debate that issue. You will hopefully find out you are wrong.

edit: If the patient clearly wants to die: thats another matter...

Edited by Prometheus98876
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So a doctor should allow a patient, whom for all he knows is usually rational to die? What if he knows the guy is normally very ratonal, but is succumbing to irrationality due to the severe stress of severe illness / injury? Should he apply this even then and let him die? If we take what you say literally, and what other way should we take it: YES. I strongly disagree with that.

It is the patient's decision and he has no right to override it, so yes. If he override the patient's decision he would be breaching the patient's rights, so yes.

That is not a valid translatioin, and not what I said. Sure, it might voilate his rights, but is it better to DIE than to have your rights violated even if so? Should the doctor beleive the patient would prefer DEATH over having his rights violated?

You are trying to justify a breach of right? That is pretty immoral and evil of you. There is never justification for rights breaches. You yourself have said as much.

I dont think so, most sane people would rather be lied to have their rights violated than to die.

Sane people would rather prefer the truth and not dying over one or the other.

This is an emergency situation, moral issues like these are absolutes never to be breached, in non-emergency situations. But in matters of life and death, it is sometimes better to commit what would normally be immoral than allow yourself to die or others to die.

Tranlation: subjective morals as opposed to onbjective morals.

If you refuse to understand this, then that is your problem, and I will not debate it. Go read up on things a bit more before you try to debate that issue. You will hopefully find out you are wrong.

Nope, I am not wrong. Breaching rights is always immoral and evil and you are sanctioning the immroal and evil. Rights violations are never justified because rights are only lost when you breach the rights of others. In almost all cases the patients has not done so, so you must respect their rights, unless they breach rights, in which case there is no rights to breach.

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You dont understand, Im not trying to justify it as such, its horrible, it might be a terrible breach of their rights, but if one beleives death is the only option, then I do not think it is evil to choose that over death. I am saying that given the choice of that or allowing one to die, it is prefferable. Can you not see this?

Edited by Prometheus98876
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