Unit Five:To Lie or Not to Lie--The Doctor's Dilemma

Is it ever proper for a medical doctor to lie to his patient? Should he tell a patient he is dying? These questions seem simple enough, but it is not so simple to give a satisfactory answer to them. Now a new light is shed on them.

TO LIE OR NOT TOLIE—
THE DOCTOR'S DILEMMA

Sissela Bok
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 to 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 months? 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 sharply 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 may 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 for truth's sake, and that is '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 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 not 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 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 easies 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 hones 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
dilemma
n. a situation in which one has to make a choice between two equally unsatisfactory things; a difficult choice 窘境，進退兩難

benefit
vt. do good to 有益于

recovery
n. the process or fact of getting back to a former state of good health; the state of recovering or being recoverd 痊愈；復得

conceal
vt. hide, keep from being seen or known 隱瞞

line
n. a business, profession, trade, etc. 行業

dwarf
vt. cause to appear small by comparison 使矮小，使相形見絀
n. a person, animal, or plant of much less than the usual size 矮小；矮小的動（植）物

shelter
vi. take shelter; find protection 躲避
vt. provide shelter for; protect 掩蔽；庇護

brutal
a. cruel, severe

uphold
vt. support 支撐；維護

secrecy
n. the practice of keeping secrets; the state of being secret

expose
vt. disclose; leave uncovered or unprotected 揭露；暴露

corruption
n. dishonesty; immoral behaviour 腐化，道德敗壞

promote
vt. help to grow or develop; raise in rank, condition, or importance 促進，推進；提升

checkup
n. a general medical examination

minimize
vt. reduce to the smallest possible amount or degree

gravity
n. the quality of being serious critical 嚴重性

confront
vt. meet face to face; oppose （勇敢地）面對；對抗

urgently
ad. in an urgent manner 緊急地，急迫地
urgent a.

self-serving
a. serving one's own interests; seeking advantage for oneself 利已的

recover
vi. get well; get back to a normal condition

deteriorate
v. (cause to ) become worse （使）惡化

suicide
n. the act of killing oneself

physician
n. a doctor of medicine 內科醫生

traditionally
ad. by tradition; in a traditional manner

precept
n. a rule of moral conduct; maxim 戒律；格言

precept
vt. rise above or go beyond the limits of; surpass 超越

virtue
n. goodness or moral excellence; a good quality 美德；優點

utter
vt. speak; give out

deceptive
a. deceiving or misleading; meant to deceive

innumerable
a. too many to be counted

placebo
n. substance given instead of real medicine to a patient for psychological effect 安慰劑

warrant
vt. justify; authorize; guarantee 使有（正當）理由；授權（給）；擔保

distort
vt. give a false account of; twist out of the usual shape 歪曲；弄歪

grave
a. serious; requiring careful consideration 嚴重的；嚴肅的

incurably
ad. beyond cure

illusory
a. deceptive and unreal; based on an illusion 虛幻的

deception
n. deceiving or being deceived; a trick intended ot deceive 欺騙；詭計

document
vt. prove or support with documents 用文件證明

contrary
a. completely different or wholly opposed 相反的；對抗的

overwhelming
a. too many, too great, or too much to be resisted 勢不可擋的；壓倒之勢的

betray
vt. be unfaithful to; deceive 背叛

truthful
a. true

humanely
ad. tenderly, kind-heartedly 仁愛地；人道地

tolerate
vt. allow or endure with protest 容忍

advocate
n. person who speaks for an idea, way of life, etc. 擁護者，倡導者

benevolent
a. intending or showing good will, kindly, friendly 仁慈的

invade
vt. enter (a country) with armed forces in order to attack; violate, interfere with 侵犯

autonomy
n. (the right of) self-government; freedom to determine one's own actions, behavior, etc. 自治（權）；自主

render
vt. cause to be

informed
a. having knowledge or information; having and using suitable knowledge 了解情況的；有見識的

concerning
prep. about, with regard to

increasingly
ad. more and more all time

befall( befell, befallen)
vt. (use. sth. bad ) happen to (sb.) 降臨到……頭上

integrity
n. honesty or sincerity; wholeness 誠實，正直；完整

credibility
n. the quality of being believable; trustworthiness 可靠性；可信

colleague
n. an associate; fellow worker or member of a profession or organization 同事

suspicion
n. doubt; mistrust 懷疑

deceit
n. deception; a dishonest trick 欺騙

undercut
vt. undermine; weaken 暗中破壞；削弱

scrupulously
ad. carefully; conscientiously 一絲不茍地

spiral
n. a curved shape which winds round; a continuous and expanding increase or decrease 螺旋（形）；盤旋上升（或下降）

lawsuit
n. a noncriminal case in a court of law 訴訟（案件）

injure
vt. cause physical harm to; damage

arise (arose)
vi. move or go upward; come into existence 上升；出現

bill
n. 法案；議案；賬單

alternative
n. a choice between two or more things; any of the things to be chosen 抉擇；可供選擇的東西

treatment
n. a substance or method used in treating someone medically 治療；療法

eloquent
a. having the power of expressing one's feeling or thoughts with grace and force 雄辯的

disapprove
vt. consider not good or not suitable; have or express an opinion against 不贊成

refrain
vi. hold oneself back; keep oneself (from doing sth.) 忍住；戒除

object
vi. be against sth. or sb. 反對

objection n.

bitterly
ad. sharply severely

deceive
vt. cause (sb.) to believe sth. that is false 欺騙

debate
vt. argue about (sth.) in an effort to persuade other people 辨論

issue
n. a question that arises for discussion 問題；爭端

practitioner
n. a professional man, esp. in medicine or in law 開業者（尤指醫生、律師等）

consequence
n. result; importance 后果；重要性

avoidable
a. that can be prevented from happening

wary
a. cautious; in the habit of looking out for possible danger or trouble 謹慎的；謹防的

erode
vt. wear away; eat into 腐蝕

saying
n. a well-known wise statement; proverb 格言；諺語

Phrases & Expressions
go on (a trip, vacation)
depart for the purpose of

at times
occasionally; now and then 間或；有時

in one's eyes
in one's opinion

for one's (own) sake
for one's own benefit 為了某人自己的利益

slip into
fall into; enter (esp. through carelessness) 陷入

contrary to
opposite to; despite

in the first place
firstly

in the course of during
during

in the dark
uninformed; ignorant 不知情，蒙在鼓里

bring to a close
end 結束，終止

take leave (of)
say goodbye (to)

in the long run
in the end; ultimately 從長遠的觀點看；最終

go to great lengths
do anything possible, however dangerous, unpleasant, wicked, etc. 不遺余力

refrain from
not do , stop

day after day
each day

take a/ one's stand
declare one's position, loyalty, opinions, etc., and be prepared to fight (for these opinions, etc.)表明立場、意見等