说谎还是不说谎医生的难题
耶稣祷告词-团队精神重要性
Unit
5
Warm-Up
Questions
1. Is it even right to tell a lie?
2. Do
you always want to be told the truth, no matter
how unpleasant?
3. Are there any circumstances
in which it is acceptable for a doctor to tell
a lie?
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 simply to
give a satisfactory answer to them.
To Lie or Not to Lie—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 doctor say, for example,
to a 46-years-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 mouths? 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 reason 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 the 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
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 coning
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; help
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 a
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 easiest to mislead
and most often kept in the dark
— can than 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,
their
credibility. Lies hurt their colleagues as well.
The suspicion of deceit undercuts the work
of
the many doctors who are scrupulously honest 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
answer. Patients’ bill
of right require that
they may be informed about their condition and
about alternatives for
treatment. Many doctors
go to great lengths to provide such information.
Yet even in hospital
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.”
[ 776 words ]
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——医生的难题
西塞拉·博克
为了对病人有好处—— 为了加快病人康复或不让病人知道死亡的来临——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——他们最容易受骗,也最会被人蒙在鼓里——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
的权利规定,
医生应将病情和可供选择的治疗方案通告病人。许多医生尽可能向病人提供这些情况,然而即使在对病人权益考虑的最周到的医院里,信奉“仁慈”欺骗的医生们继续他们传
统古老做法。
同事们也不赞同,但避免公开表示反对。护士们对不得不日复一日地参与
欺骗病人的做法也许深恶痛绝,
但要抵制却感到无能为力。
及时对这个问题进行公开辩论非常必要。不仅在医疗事业,而且在其他行业
,从业
者不断发现,自己常处于似乎不采用欺骗手段就无法避免保持警惕,因为这种做法特别
容
易根深蒂固,蔓延滋长,并损害信任。无论医疗界、法律界、政府界机构还是社会科
学界,都不应从“不
知者不为所害”这句老话中得到丝毫慰藉。
Unit
5
Warm-Up
Questions
1. Is it even
right to tell a lie?
2. Do you always want to
be told the truth, no matter how unpleasant?
3. Are there any circumstances in which it is
acceptable for a doctor to tell
a lie?
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 simply to give a satisfactory answer
to them.
To Lie or Not to
Lie—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 doctor say, for example,
to a 46-years-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 mouths? 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 reason 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 the 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
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 coning
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; help
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 a
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 easiest to mislead
and most often kept in the dark
— can than 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,
their
credibility. Lies hurt their colleagues as well.
The suspicion of deceit undercuts the work
of
the many doctors who are scrupulously honest 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
answer. Patients’ bill
of right require that
they may be informed about their condition and
about alternatives for
treatment. Many doctors
go to great lengths to provide such information.
Yet even in hospital
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.”
[ 776 words ]
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——医生的难题
西塞拉·博克
为了对病人有好处—— 为了加快病人康复或不让病人知道死亡的来临——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——他们最容易受骗,也最会被人蒙在鼓里——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
的权利规定,
医生应将病情和可供选择的治疗方案通告病人。许多医生尽可能向病人提供这些情况,然而即使在对病人权益考虑的最周到的医院里,信奉“仁慈”欺骗的医生们继续他们传
统古老做法。
同事们也不赞同,但避免公开表示反对。护士们对不得不日复一日地参与
欺骗病人的做法也许深恶痛绝,
但要抵制却感到无能为力。
及时对这个问题进行公开辩论非常必要。不仅在医疗事业,而且在其他行业
,从业
者不断发现,自己常处于似乎不采用欺骗手段就无法避免保持警惕,因为这种做法特别
容
易根深蒂固,蔓延滋长,并损害信任。无论医疗界、法律界、政府界机构还是社会科
学界,都不应从“不
知者不为所害”这句老话中得到丝毫慰藉。