第五册第四单元谎言补充文章

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: %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 \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 \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 \

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, \

New Words dilemma

n. a situation in which one has to make a choice between two equally unsatisfactory things; a difficult choice 窘境，进退两难 line

n. a business, profession, trade, etc. 行业 dwarf

vt. cause to appear small by comparison 使矮小，使相形见绌

n. a person, animal, or plant of much less than the usual size 矮小；矮小的动（植）物 uphold

vt. support 支撑；维护 secrecy

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

n. dishonesty; immoral behaviour 腐化，道德败坏 checkup

n. a general medical examination minimize

vt. reduce to the smallest possible amount or degree gravity

n. the quality of being serious critical 严重性 confront

vt. meet face to face; oppose （勇敢地）面对；对抗 self-serving

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

v. (cause to ) become worse （使）恶化 physician

n. a doctor of medicine 内科医生 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 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 安慰剂 warrant

vt. justify; authorize; guarantee 使有（正当）理由；授权（给）；担保 distort

vt. give a false account of; twist out of the usual shape 歪曲；弄歪 incurably ad. beyond cure illusory

a. deceptive and unreal; based on an illusion 虚幻的

deception

n. deceiving or being deceived; a trick intended to deceive 欺骗；诡计 document

vt. prove or support with documents 用文件证明 overwhelming

a. too many, too great, or too much to be resisted 势不可挡的；压倒之势的 humanely

ad. tenderly, kind-heartedly 仁爱地；人道地 benevolent

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

n. (the right of) self-government; freedom to determine one's own actions, behavior, etc. 自治（权）；自主 render vt. cause to be concerning

prep. about, with regard to befall( befell, befallen)

vt. (use. sth. bad ) happen to (sb.) 降临到……头上 integrity

n. honesty or sincerity; wholeness 诚实，正直；完整 credibility

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

n. deception; a dishonest trick 欺骗 undercut

vt. undermine; weaken 暗中破坏；削弱 scrupulously

ad. carefully; conscientiously 一丝不苟地 spiral

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

n. a noncriminal case in a court of law 诉讼（案件） bill

n. 法案；议案；账单 alternative

n. a choice between two or more things; any of the things to be chosen 抉择；可供选择的东西 eloquent

a. having the power of expressing one's feeling or thoughts with grace and force 雄辩的 disapprove

vt. consider not good or not suitable; have or express an opinion against 不赞成 refrain

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

n. a professional man, esp. in medicine or in law 开业者（尤指医生、律师等） wary

a. cautious; in the habit of looking out for possible danger or trouble 谨慎的；谨防的 erode

vt. wear away; eat into 腐蚀

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