Honestly, I would have thought that a post about why doctors lying to patients is verboten would be wholly unnecessary. Just like “doctors mustn’t operate on their patients while intoxicated” or “doctors mustn’t rifle through their patients’ belongings while they’re under anesthesia,” “doctors mustn’t lie to their patients” seems so obvious as to be beyond stating. But it seems I was wrong in thinking this way, as some of the comments about one of Rose’s recent posts seem to indicate. Further, there is an implication that this prohibition against lying stems from “professional ethics” understood to be some kind of collective handshake we all shared between rounds of golf at a conference one day, rather than a well-thought-out system of professional probity built on the rubble of some rather horrible historical mistakes. Which is, of course, what it really is.
Let us begin with the rather easy slippery slope argument, which in this case is more like a well-greased fireman’s pole. If doctors are legally permitted to lie to their patients to prevent abortions (a discussion of which started this whole conversation, and which I do not think is actually permitted by certain recent legislation), what other things are we allowed to lie about in service to our own moral reasoning? Am I allowed to lie about the prognosis of a terminal cancer because I fear the patient may commit suicide? Conversely (in an example suggested by BSK in that same comment thread linked above), am I allowed to lie about the possibility of recovery for an injured patient because I know his kidneys and liver might help patients awaiting transplant? Am I allowed to tell a woman I’m treating her for a yeast infection, rather than the chlamydia she got from her philandering husband, because I disapprove of divorce? Am I allowed to withhold from patients that they are infected with syphilis because I believe the greater good will be served by learning from how it ravages their bodies?
I sincerely hope that the answer to all of these questions is a resounding “no” from everyone.
The physician-patient relationship exists within a great differential of information, privilege and power. Physicians know how to interpret signs and results about patients’ own bodies that they themselves cannot. They are given the privilege of prescribing medications, including those that are dangerous and/or addictive. They can give patients access to special services, and excuse them from work or school or civic duties. They can perform risky and invasive procedures. And since patients often want or need these things, physicians have greater power in the relationship. Medical ethics are a means by which the ill effects of that power differential are mitigated.
Giving patients accurate and comprehensive information about their health and allowing them to make their own best decisions is a foundational part of medical ethics. It is obvious reason for informed consent laws. It is the reason that any research hospital has a institutional review board to ensure that those enrolled in medical studies have been given all the information they need about risks and benefits to make their own choices, and are not being pressured or coerced. It cannot be dispensed with.
Withholding or tampering with information in order to manipulate a patient into a choice we think she should make is exploiting rather than obviating the power differential in the physician-patient relationship. If the choice is a moral one, we are robbing her of her moral agency and substituting our own. I am confounded in the extreme that anyone would argue otherwise. Arguing further that this evil is necessary to prevent another evil (such as abortion) makes us magistrates rather than healers, and invests us with powers that are not rightly ours. We are charged with caring for our patients’ health, not dictating their moral choices.
My esteemed interlocutor and fellow Ordinary made reference to the Nazi regime in his comments, and so perhaps I may be forgiven for doing so myself. In medical school, when I was taught about medical ethics I was reminded that one of history’s greatest monsters was a doctor. Were I one who believed in hell, I would reserve a place of special darkness for him. He was not discussed as some kind of rhetorical figure, meant to score a point in an argument about right or wrong. He was discussed as a reminder to all of us that we are given a role in society that comes with a solemn responsibility to never, ever allow such hideous perversions of our work as physicians to come to pass again. We must never abuse the privileges and prerogatives of our profession.
I neither want nor should be granted the power to subvert my patients’ moral agency, and there must never come a time when I or any of my colleagues are given the legal capacity to do so.