Yeah, some people just like to debate endlessly in heated tones sadly.
Fortunately none of them are in this thread.
I never said anything about prefering the truth and death. I said the truth and life. There is nothing irrational about preferrong the truth and life. It is in fact quite ratiuonal.
I am _ extremely _ doubtful that this has ever happened or could ever happen. If you could provide me with even one case of it I would be extremely surprised, but I doubt you can do that.
How many times do I have to say I was not talking about preferring truth over life, but that I was talking about preferring _ BOTH _? At least half a dozen so far, and it still has not sunk in yet. I am starting to doubt it ever will.
Your statement hasn’t ‘sunk in’ yet because the topic at hand does not have the option of both truth and life. It is obvious that one would prefer the truth and life over lies and life… but if the situation doesn’t allow for the preferred option, would you take a lie and life over truth and death? Personally, I would rather be lied to and live than be told the truth and die. And yes, I would rather be told the truth and live than either of those two options, but this topic assumes that can’t be done.
My point is that knowing the truth and living is superior to living and being lied to. Besides, in lying to them you are saying they are incapable of handling the truth, which is insulting.
No, you’re not saying that at all. Let’s see if I can come up with some decent example situations here. I know these situations aren’t quite possible (I’m not a medical person by any means) but they should get the point across.
I’m having a stroke. Now, I know that strokes are caused by blood clots that prevent blood from reaching my brain. The longer one waits to receive treatment, the more brain damage one ends up with, so I want the doctor to work quickly. Because I know what causes strokes, I know that my treatment should consist of a clot-busting drug, or something that thins my blood. Certainly the last thing I would want is a blood thickener.
Now, the doctor knows of some recent research that shows that a blood thickener actually helps more than the treatment I expect, but when he tells me this I get upset because I don’t believe it could be true. The longer the doctor spends trying to convince me of the safety of the new drug, the more brain damage I get. At this point, I would prefer it if the doctor gave me the new drug even though I don’t think I want in (in other words, lie to me) so I would get better, and then later (when I’m out of danger) explain what he did and why, along with some of the experiments that show this drug was better than the treatment I had been expecting. (Note: the doctor also knew that I wanted effective treatment.)
It wasn’t that the doctor thought I was incapable of handling the truth; it was my lack of knowledge and lack of time that prevented him from telling me.
Now an example relating to the original topic, involving psychology more than physical treatment (this one will be even worse medically, almost ridiculous. Sorry about that.)
My sister has an infection of some sort. I know that this particular type of infection can be deadly, and her chances of surviving it are not good. She asks me if she’s going to live through it. “Yes, Amy, you’re going to get through this.” Now Amy, believing that she’s going to survive, is happier. Her brain releases more endorphins. The endorphins help her immune system kick into overdrive, and (with the help of some drugs as well) she fights off the infection. Without those extra endorphins (in other words, if I’d told her the truth instead of telling her she’d survive) she would have died.
And, of course, RationalBiker’s got some excellent points as well. I do not think I would deal well with lots of pain. I really have no idea what it would take for someone to convince me that a treatment I thought was the wrong one was actually the right one when I’m in pain, or if I’ve had a major concussion, etc. I would prefer it if they just gave me the right treatment while telling me that it’s the treatment I expected, and later, when I’m better, they can explain.
A lie would only make a difference to an irrational person, not a rational person. So in lying you are catering top their irrationality.
First, you missed the point that I made, which was that in such an emergency, the abstract value of brutal truth is trumped by the physical harm. When man is again living in “metaphysically normal” conditions and has some minutes to reflect on matters, then truth would be totally appropriate. Second, if you have the purpose of saving a life rather than enforcing a particular psychological code of conduct on another, you are being irrational to pursue the latter as your primary goal when you’ve persuaded yourself that it’s the former that you’re interested in. I agree that if a person has no interest in saving a life and just wants to teach someone a moral lesson, you shouldn’t lie – in that circumstance you should just walk away and let them die, because they are not your responsibility.
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.
I think I also addressed that: this isn’t about the informed consent issue, it’s about whether telling a man who has had the lower half of his body blown off that there’s only a 40% that he will survive. The patient’s only right to the truth comes from his right to refuse treatment.
How is telling someone “don’t worry, you’re going to be fine” a lie? Whether they live or die, it’s still true: they stop being scared and hurt. Now, if you told someone “you’re not going to die” in any situation, even if you just met them walking down the street, it’d be a lie because everyone dies sometime.
My advice: if you’re worried about being absolutely honest in all situations (as you should be), learn to tell the truth in such a way as to give only the information you want. You don’t want to tell them how badly they’re hurt? Then don’t. Tell them you need them to talk to you. Tell them you’re a really good doctor. They’re in shock, it’s not like they’re really listening to you all that closely.
There’s a world of difference between saying, “Don’t worry, no one ever dies from X injury” and saying “Don’t worry, the hospital we’re going to has the best staff in the state!” Both are comforting. The first one is false.
Wow, this thread got a lot more responses than I expected! Some replies:
punk: To a certain extent, the provider of the first aid is dealing with a person (the victim) for whom he does know better than the victim what is good for the victim, since the victim’s injuries make it difficult for him to be rational. The attitude that you know better than other people what is good for them is not bad intrinsicly, but only insofar as it tends to produce wrong answers or poor recommendations.
DragonMaci: Regardless of whether or not lying to a victim in an emergency is wrong, it is certainly not wrong in the same way as lying to a patient who is ill but capable of rationality in the context of deciding among treatment options in a hospital setting. The right to refuse treatment does not make sense for an individual who is incapable of evaluating the treatment. Also, I assumed implicitly (and I thought, obviously) that we were not talking about a first aid provider treating a victim who the provider knew had signed a “Do Not Resuscitate” order.
I think you’re making errors as a result of ignoring the explanation of principles. You cited the principles that whim-worship is wrong and that nothing can be gained from lying. But why is whim-worship wrong? Because insofar as you are rational, it won’t do you any good. Likewise, only the rational gain nothing (or at least expect overall to gain nothing) from lying. But my point is that the victim in an emergency has had his ability to be rational damaged, the standard explanations for why certain classes of action are wrong no longer applies, because those explanations presuppose rationality.
Another example of the same thing (I think): you denounce lying to victims in an emergency as catering to irrationality, because lying could be good for them only if they were irrational. True, but then why is catering to irrationality wrong? Because in ordinary circumstances, it encourages more irrationality. But catering to the irrationality which is the result of some sort of modification of the individual in question’s body (such as drugs or an injury) is not the same as catering to the irrationality which is the result of ideas which the individual has consciously accepted. I am not familiar with the specific arguments used, but I suspect that traditional explanations for the immorality of catering to irrationality are directed at catering to the second kind of irrationality, the irrationality which results from accepting bad ideas.
Imagine that you are dealing with some Phinneas Guage-like victim of a brain injury who is no longer capable of irrationality. Whether or not you cater to his irrationality will have no effect on how irrational he is, because he will be irrational no matter what happens, so your decision should only rest on whether catering to his irrationality is likely to benefit you. Now suppose you are dealing with a seriously injured friend who is rational most of the time. His injury prevents him from being rational now, so you ask yourself whether catering to his irrationality will benefit you. My first aid teacher would argue that under certain circumstances, catering to his irrationality increases the chances that he will go on to become rational again, and thus you would benefit.
JMeganSnow and others: You have suggested that rather than lie to the patient or tell him the brutal truth, you tell him something that calms him down but is not in fact a lie. Obviously, if you can have the best of both worlds like this, you should. However, I thought it was clear that my question asks us to consider situations where a lie is more effective than a calming truth. After all, if you can avoid the ethical dilemma so easily, then there is no point in considering it. And I suspect that the ethical dilemma cannot be so easily avoided, because I can see how certain types of lies would be effective. For example, suppose you have a person who has been shot and you are trying to treat him for shock while you wait for the ambulance. One thing I would consider doing in this case was assuring the victim that only a very small percentage of people with injuries similar in specific respects to theirs (i.e. similar caliber, wound location, angle of entry, etc.) actually die. This use of specific information would help to fool the victim into believing that I was an expert, and therefore if I said they were going to be okay, they should trust me, thus improving their state of mind and their chances of survival. Once they woke up after surgery, I would apologize to them for being dishonest.
JMeganSnow and others: You have suggested that rather than lie to the patient or tell him the brutal truth, you tell him something that calms him down but is not in fact a lie. Obviously, if you can have the best of both worlds like this, you should. However, I thought it was clear that my question asks us to consider situations where a lie is more effective than a calming truth.
That’s like asking us to consider, hypothetically, a situation where little green men are controling us via beams of radiation from Mars. First you need to demonstrate that this situation happens AND that it happens with enough frequency to require a principle to govern it.
How much “more effective” are we talking here? 10%? 0.002%? How would you even measure that? Certainly your test cases would vary wildly and, given the number of factors that all come together in an emergency situation, it would be impossible or nearly so to factor out the various other influences at work and narrow it down to 1 person telling the patient a specific lie.
Let me put it like this: from a principled standpoint, your hypothetical is horse poo . . . as are most “emergency” hypotheticals along the same lines.
I postulate that there are some situations in which it would be “better” to tell the patient that they ARE going to die even if they probably AREN’T. Adrenalin can have some nice beneficial effects in an emergency situation, like getting someone to pull themselves back up over a cliff. I’m going to start a new school of patient treatment called the “worst case scenario” school in which you always tell the patient that the worst possible thing that could happen is going to happen with absolute certainty. People would come into my medical clinic with a splinter and be told they were going to get an antibiotic-resistant form of tetanus and die. They’d be so indignant that their muscles would clench and fire the offending splinter across the room like a 20mm shell. Then I’d bill them hundreds of dollars for the privilege of pissing them off. It’d be great!
That’s like asking us to consider, hypothetically, a situation where little green men are controling us via beams of radiation from Mars.
No it isn’t, because we are all sure that little green men are not controlling us with beams of radiation, but we aren’t all sure that there aren’t any situations where a lie is more beneficial to a victim than the truth. Also, most people would be willing to give more credence to the claim that lying can help the injured in some cases than to the claim that we are being controlled by aliens. Surely you do not think that we are all fools to do so?
First you need to demonstrate that this situation happens AND that it happens with enough frequency to require a principle to govern it.
I disagree. I think it is enough that the event in question be possible, and at least not absurdly unlikely (i.e. it is within the scope of things which might matter to us). Also, if we agree that lying is a dominant strategy in this case, that is that any situation that would be helped by a calming truth would be helped by a lie, but in principle a lie might help in a situation where a calming truth wouldn’t (for example, where the victim is in a pessimistic frame of mind), then we could conclude that lying was the best move in the situation without having to determine how likely the event that a lie was better than a calming truth was.
How much “more effective” are we talking here? 10%? 0.002%? How would you even measure that? Certainly your test cases would vary wildly and, given the number of factors that all come together in an emergency situation, it would be impossible or nearly so to factor out the various other influences at work and narrow it down to 1 person telling the patient a specific lie.
Just because demonstrating the effect of medical procedures or therapies is hard doesn’t mean we can’t do it. For example, we could group cases into types of injuries, and then measure the effectiveness of lying on victims with certain classes of injuries. Of course, there are all kinds of issues that come up in designing an experiment to test this claim, but that doesn’t mean it can’t be done.
I postulate that there are some situations in which it would be “better” to tell the patient that they ARE going to die even if they probably AREN’T.
You might well be right, in which case just as doctors study which medicines cure which diseases, they might also want to know which situations call for lies, and of those situations, which kinds of lies. The claim that you ought to lie one way under certain circumstances in no way implies that you ought not to lie another way under different circumstances.
Just to follow up on my comment earlier. I actually was having a great discussion with a friend of mine at work tonight. She used to be an EMT, and she told me that she and they(the station she worked for) never purposely lied to the patients in the truck, nor advocate doing so, but said things that were right along the lines of the one that I had thought of before…hmmmm…more reason why she’s my friend… She said that she usually is the one directing the questions, calming then down, telling them that they are here to do everything they can for them, “My job is to get you to the hospital…and I’m very very good at my job…” “I’m going to fight through this with you, and when we get to the hospital, there will be an army there ready to fight for you…” and so forth. She even told me about the infants life she saved…which was so touching… I also found out that her niece is a published poet… 
No it isn’t, because we are all sure that little green men are not controlling us with beams of radiation, but we aren’t all sure that there aren’t any situations where a lie is more beneficial to a victim than the truth. Also, most people would be willing to give more credence to the claim that lying can help the injured in some cases than to the claim that we are being controlled by aliens. Surely you do not think that we are all fools to do so?
So you’re saying that the fact that more people believe something necessarily means that it is more true and deserves more consideration? Yeah, right. Pull the other one, it has bells on. There are a hell of a lot of people willing to “give credence” to the claim that socialism is good for people, that doesn’t make it any more true than it already is.
Basically, all your claims are completely arbitrary and deserve exactly as much “credence” as the idea of little green men from mars.
Interesting thread. To sum up my opinions:
If I am the patient, and it’s truly an emergency, then lie to me all you want to calm me down. If Kelly was hurt and was freaking out, I would tell her she’s going to be fine no matter how she looked. I would try to comfort her and calm her down. That said, I don’t see how lying about specifics would be necessary.
As for the doctor lying to the patient about a treatment that the patient doesn’t understand: If I were the doctor, then I would lie if I thought it would save the patient’s life. As for a violation of rights, I think about it from the judge’s perspective if such a case went to court. If the patient really wanted to die, then maybe he could sue the doctor for the cost of doctor-assisted suicide, plus additional damages for pain and suffering. If the patient really wanted to live, and the doctor gave him a life-saving treatment against his wishes, and then the patient sued the doctor, then I would never allow the case to even get to court. If the case did make it to court, then I would have the patient pay for the doctor’s legal expenses, tell him he’s a fool, and throw him out of my courtroom.
–Dan Edge
As for a violation of rights, I think about it from the judge’s perspective if such a case went to court. If the patient really wanted to die, then maybe he could sue the doctor for the cost of doctor-assisted suicide, plus additional damages for pain and suffering. If the patient really wanted to live, and the doctor gave him a life-saving treatment against his wishes, and then the patient sued the doctor, then I would never allow the case to even get to court.
There are two cases that you don’t cover, the important ones. One is if you lie to the patient to secure permission to undertake the treatment, perform the procedure, and the patient does not get better (arguably as a result of the treatment). Then you would rightly be in deep doo-doo. Second, you could lie about the nature of the treatment and save a patient’s life which might, for example, involve a blood transfusion (and the patient is a Jehovah’s Witless). While I think their transfusion-avoidance belief is lunacy, it’s their right to be lunatic, and thus it is a wrongful assault to treat a patient in a way that they do not / would not consent to, and covering up the fact that an aspect of the procedure involves something that is moral anathema to the patient is a wrongful act. In that case, the doctor should tell the truth to the patient, should not obscure the central point if there is confusion (“Yes, this does involve transplanting an organ”), and should act in accordance with the permission granted by the patient. To do otherwise is, plain and simple, assault. Even if it’s surgery on an idiot.
The point here is that lying is not generally good but it can be okay in certain cases, to calm a patient who might otherwise die from shock. But in pursuit of the goal of saving the patient’s life, you cannot negate the higher requirement of informed consent.
David,
One is if you lie to the patient to secure permission to undertake the treatment, perform the procedure, and the patient does not get better (arguably as a result of the treatment). Then you would rightly be in deep doo-doo.
I agree fully.
Second, you could lie about the nature of the treatment and save a patient’s life which might, for example, involve a blood transfusion (and the patient is a Jehovah’s Witless). While I think their transfusion-avoidance belief is lunacy, it’s their right to be lunatic, and thus it is a wrongful assault to treat a patient in a way that they do not / would not consent to, and covering up the fact that an aspect of the procedure involves something that is moral anathema to the patient is a wrongful act.
That’s an interesting case. I don’t know if the Jehovah’s Witness could win a civil suit against the doctor, but you suggest the state should punish the doctor for assault. This would also most likely violate hospital policy, and the doctor could be fired. That said, if I am the judge in his criminal case, and the doctor is a 1st time offender, I still probably throw the case out of court.
I wonder what hospital policy would be if it weren’t for all the regulations placed on them today? Could a hospital require that, if you come in for emergency care, then you must allow the doctors to perform certain procedures (like blood transfusion)? Since it may be hard to prove that the patient refused certain forms of treatment, it may be in the hospital’s best interest to require that one consent to certain procedures before admitting him for emergency treatment. They don’t want to get sued by the patients family if he dies.
I’m getting off the subject though. The original question was one of ethics, not legality.
–Dan Edge
I think you’re blurring the context of an “emergency” here. An emergency of the type where a lie might actually make a difference is when a building has fallen on someone and severed their leg and they’re going to bleed out in sixty seconds if you don’t do something. In that context, having a patient that is ranting, trying to sit up, fighting the people applying the tourinquet, etc. is a huge problem, and you can’t necessarily just pump them full of drugs to make them behave because that might cause heart failure.
I still think putting your knee on their chest and announcing that they WILL die if they DON’T HOLD STILL is the best thing to do, but I don’t like people that get hysterical in a crisis so it’s no skin off my nose if they die from their own stupidity. This is probably one of the reasons why it’s a good thing I’m not a doctor or EMT.
Jennifer,
If you ever find me sprawled out in the office, wounded and frantic, just go get the paramedics. Please don’t hold me down and say, “Dan, you are going to die very soon unless you calm down! You’re dying! You’re going to die! You’re mere moments from death, fool! Say hello to my great-great-grandmother for me! Except that there’s no afterlife; your existence will just end, and very soon! Chill, dead boy!”
–Dan Edge
I think the first thing I’ll do will be to ask, “how did you manage to do that with a stapler?”