Unit Five 
Text
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 TO LIE---
THE DOCTOR'S DULEMMA
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 oftem seem dwarfed by
greater needs: the need to shelter from brutal news or to uphold a promise
5 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
10 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?
Doetors confront such choices often and urgently. At times, they see
important reasons to lie for the patient's own sake; in their eyes, such
15 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:
20 "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
25 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 pro-
duce is naw coming to be documented. Studies show that, contrary to the
30 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 infor-
mation, humanely conveyed, helps patients cope with illness : helps them
tolerate pain better, need less medicine, and even recover faste after
35 surgery.
Not only do lies not provide the "help" hoped for by advocates of
benevohnt 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
40 increasingly aware of all that can befall patients in the course of their
illness when information is derued or distorted.
Dying patients especially -- who are easiest 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
45 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 suspicfon of deceit undercuts the work of the many doctors who are
50 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
answers. Patients'bills of rights require that they be informed about their
55 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
ageold practices. Colleagues may disapprove but refrain from objecting.
Nurses may bitterly resent having to take part, day after day, in deceiving
60 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 repea-
tedly in difficulty where serious consequences seem avoidable only through
deception. Yet the public has every reason to be wary of professional
65 deception; for such practices are peculiarly likely to become deeply rooted,
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,进退两难
beneilt 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; 复得
conceal / vt. hide, keep from being seen or known 隐瞒
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 矮子; 矮小的动(植)物
shelter vi. take,shelter; find protection 躲避
vt. provide shelter for; protect 掩蔽; 庇护
brutal / a. cruel; severe
uphold vt. support 支撑; 维护
seerecy / 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;道德败坏
promote / vt. help to grow or develop;raise in rank,condition, or
impor tance 促进,推进;提升
checkup n. a general medical examinatiori
minimize / vt. reduce to the smallest possible amount or degree
gravity / n. the quality of being serious or critical 严重性
eonfront / vt. meet face to face; oppose (勇敢地)面对;对抗
urgently / ad . in an urgent manner 紧急地, 急迫地
urgent a.
self-serving a. serving one's own interests; seeking advantage for
oneself 利己地
recover / vi. get well; get back to a normal condition
deteriorate / v. (cause to) become worse (使)恶化
suicide / n. the act of killing oneself
physician / n. a doctor of medicine 内科医生
traditionally ad. by tradition; in a traditional manner
precept / n. a rule of moral conduct; maxim 戒律; 格言
transcend / vt. rise above or go beyond the limits of ;surpass 超越
virtue / n. goodness or moral excellence;a good quality 美德;
优点
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 toapatient
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
grave / a. serious; requiring careful consideration 严重的;严肃的
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
contrary / a. completely different or wholly opposed 相反的; 对抗的
overwhelming / a. too many, too great, or too mueh to be resisted 势不可
挡的;压倒之势的
betray / vt. be unfaithful to; deceive 背叛
truthful a. true
humanely /ad. tenderly, kind-heartedly 仁爱地; 人道地
tolerate / vt. allow or endure without protest 容忍
advocate / n. a person who speaks for an idea,way of life, etc. 拥护者,
倡导者
benevolent / a. intending or showing good will, kindly, friendly 仁慈的
invsde / 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(权)；自主
render / vt. cause to be
infortned a. having knowledge or information;having and using suita-
ble knowledge 了解情况的; 有见识的
concerning prep. about, with regard to
increasingly ad. more and more all the time
befall (befell, befallen) vt. (usu.sth.bad) happen to (sb.) 降临到…头上
integrity /in'tegriti/ n. honesty or sincerity; wholeness 诚实, 正直;完整
credibility /,krsdi'biliti/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 怀疑
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 and round; a continuous
and expanding inerease or decrease 螺旋(形);盘旋上升
lawsuit / n. a noncriminal case in a court of law 诉讼(案件)
injure / vt. cause physical harm to; damage
arise/ move or go upward;come into existence 上升;
vi . 出现
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
treatment n. a substance or method used in treating someone medically
治疗; 疗法
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
object / vi. be against sth. or sb. 反对
objection n.
bitterly/ ad. sharply, severely
deceive /vt. cause (sb: ) to believe sth. that is false 欺骗
debate / vt. argue about (sth.)in an effort to persuade other people 辩论
issue n. a question that arises for discussion 问题; 争端
practitioner / n. a professional man,esp.in medicine or in law 开业者(尤指
医生，律师等)
consequence / result; importance 后果; 重要性
n.
avoidable a. that can be prevented from happening
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
saying n. a well-known wise statement; proverb 格言； 谚语
Phrases & Expressions
go on (a trip,vacation) depart for the purpose of
at times occasionally; now and then 间或; 有时
in one's eyes in one' s opinion
for one's ( own ) sake for one's own benefit 为了某人自己的利益
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
in the dark uninformed; ignorant 不知情, 蒙在鼓里
bring to a close end 结束, 终止
take leave ( of ) say goodbye ( to )
in the long rtm in the end; ultimately 从长远的观点看;最终
go to great lengths do anything possible, however dangerous, unpleasant,
wicked, etc. 不遗余力
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
立场, 意见等
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