Personal autonomy is often lauded as a key value in contemporary Western bioethics. Though the claim that there is an important relationship between autonomy and rationality is often treated as uncontroversial in this sphere, there is also considerable disagreement about how we should cash out the relationship. In particular, it is unclear whether a rationalist view of autonomy can be compatible with legal judgments that enshrine a patient's right to refuse medical treatment, regardless of whether the reasons underpinning the choice (...) are known and rational, or indeed whether they even exist. Jonathan Pugh brings recent philosophical work on the nature of rationality to bear on the question of how we should understand personal autonomy in contemporary bioethics. In doing so, he develops a new framework for thinking about the concept of autonomy, one that is grounded in an understanding of the different roles that rational beliefs and rational desires have to play in it. Pugh's account allows for a deeper understanding of d the relationship between our freedom to act and our capacity to decide autonomously. His rationalist perspective is contrasted with other prominent accounts of autonomy in bioethics, and the revisionary implications it has for practical questions in biomedicine are also outlined. (shrink)

Medical personnel sometimes face a seeming conflict between a duty to respect patient confidentiality and a duty to warn or protect endangered third parties. The conventional answer to dilemmas of this sort is that, in certain circumstances, medical professionals have an obligation to breach confidentiality. Kenneth Kipnis has argued, however, that the conventional wisdom on the nature of medical confidentiality is mistaken. Kipnis argues that the obligation to respect patient confidentiality is unqualified or absolute, since unqualified policies can save more (...) lives in the long run. In this paper, I identify the form of Kipnis’s argument and present a challenge to it. I conclude that, as matters stand now, a qualified confidentiality policy is the more rational choice. (shrink)

In this paper, I argue that deceptive placebo use can be morally permissible, on the grounds that the deception involved in the prescription of deceptive placebos can differ in kind to the sorts of deception that undermine personal autonomy. In order to argue this, I shall first delineate two accounts of why deception is inimical to autonomy. On these accounts, deception is understood to be inimical to the deceived agent’s autonomy because it either involves subjugating the deceived agent’s will to (...) another’s authority or because it precludes the agent from acting effectively in pursuit of their ends. I shall argue that providing an agent with false beliefs is not inimical to their autonomy if they are only able to effectively pursue their autonomously chosen ends by virtue of holding those particular false beliefs. Finally, I show that deceptive placebo use need only involve this latter sort of deception. (shrink)

All’interno del dibattito sulla definizione filosofica della menzogna, alcuni autori hanno sostenuto che mentire è sempre sbagliato. Margolis, in particolare, ha espresso la tesi radicale secondo cui “mentire è moralmente sbagliato” è una tautologia. Nella prima parte dell’articolo introduco la tesi di Margolis, e ne difendo la plausibilità contro le semplificazioni che ha subito all’interno del dibattito filosofico, mostrando che l’applicazione condizionale del predicato “sbagliato” consente di trattare in modo adeguato alcune menzogne intuitivamente giustificabili. Nella seconda parte argomento che, nonostante (...) questo stratagemma, non è possibile difendere la tesi che “mentire è moralmente sbagliato” sia una tautologia, perché bisognerebbe assumere che “mentire è moralmente sbagliato” sia una condizione necessaria fra quelle che definiscono il concetto stesso di menzogna. Questo non è desiderabile perché, come dimostro nella parte finale del mio articolo, ogni definizione di menzogna che incorpori requisiti morali nelle sue condizioni necessarie é destinata a contraddire le intuizioni del senso comune su che cos’é una menzogna. La conclusione è che la tesi che “mentire è moralmente è sbagliato” è una tautologia non può essere difesa, se non al prezzo, troppo alto, di ridefinire in modo controintuitivo il significato del termine “menzogna”. (shrink)

This article challenges Jennifer Jackson's recent defence of doctors' rights to deceive patients. Jackson maintains there is a general moral difference between lying and intentional deception: while doctors have a prima facie duty not to lie, there is no such obligation to avoid deception. This paper argues 1) that an examination of cases shows that lying and deception are often morally equivalent, and 2) that Jackson's position is premised on a species of moral functionalism that misconstrues the nature of moral (...) obligation. Against Jackson, it is argued that both lying and intentional deception are wrong where they infringe a patient's right to autonomy or his/her right to be treated with dignity. These rights represent 'deontological constraints' on action, defining what we must not do whatever the functional value of the consequences. Medical ethics must recognise such constraints if it is to contribute to the moral integrity of medical practice. (shrink)

This article offers a qualified defence of the view that there is a moral difference between telling lies to one's patients, and deceiving them without lying. However, I take issue with certain arguments offered by Jennifer Jackson in support of the same conclusion. In particular, I challenge her claim that to deny that there is such a moral difference makes sense only within a utilitarian framework, and I cast doubt on the aptness of some of her examples of non-lying deception. (...) But I argue that lies have a greater tendency to damage trust than does non-lying deception, and suggest that since many doctors do believe there is a moral boundary between the two types of deception, encouraging them to violate that boundary may have adverse general effects on their moral sensibilities. (shrink)

Does it signify morally whether a deception is achieved by a lie or some other way? David Bakhurst has challenged my view that it can signify. Here I counter his criticisms--firstly, by clarifying the terminology: What counts as a lie? Secondly, by exploring further what makes lying wrong. Bakhurst maintains that lying is wrong in that it infringes autonomy--and other deceiving stratagems, he says, do so equally. I maintain that lying is wrong in that it endangers trust--and other types of (...) deceiving stratagems do not do so equally. Lying to patients, I contend, is an abuse of their trust. Other forms of their intentional deception need not be so, although, in our autonomy-minded culture, they are likely to be so. (shrink)

Hysteria is thought to involve the unconscious production of symptoms that resemble neurological disorders. However, it is not usually possible to distinguish this from deception, leading some authors to advocate dropping the distinction. In this paper, I argue that deception is not a unitary concept, so that hysteria may indeed involve a form of deception without necessarily the ethical implications of lying. The evidence for and against deception in hysteria is considered, and a taxonomy of deception outlined. The evidence is (...) argued to support deception as a sufficient model for hysteria, though not necessarily in the form of lying, and not such as to exclude other models for much of their behavior. An appreciation of the distinct forms of deception may help clinicians to clarify their relationships with their patients with hysteria, and clarify the distinction from malingering. (shrink)

Hysteria is thought to involve the unconscious production of symptoms that resemble neurological disorders. However, it is not usually possible to distinguish this from deception, leading some authors to advocate dropping the distinction. In this paper, I argue that deception is not a unitary concept, so that hysteria may indeed involve a form of deception without necessarily the ethical implications of lying. The evidence for and against deception in hysteria is considered, and a taxonomy of deception outlined. The evidence is (...) argued to support deception as a sufficient model for hysteria, though not necessarily in the form of lying, and not such as to exclude other models for much of their behavior. An appreciation of the distinct forms of deception may help clinicians to clarify their relationships with their patients with hysteria, and clarify the distinction from malingering. (shrink)

Arguments about the morality of the use of deception in patient care have been conducted largely in an empirical vacuum, with few data about the situations in which deception occurs. Do staff frequently deceive their patients and, if so, under what conditions? Can the consequences of deception always be foreseen? What justifications do staff use to explain their behaviour? The small-scale study reported here on the uses of deception by nurses when attempting to reassure patients provides information on these questions. (...) The results suggest that deception can have deleterious effects on trust and increase the emotional distance between patients and staff. (shrink)

Background: There is a lack of empirical data on lay attitudes toward different sorts of deception in medicine. However, lay attitudes toward deception should be taken into account when we consider whether deception is ever permissible in a medical context. The objective of this study was to examine lay attitudes of U.S. citizens toward different sorts of deception across different medical contexts. Methods: A one-time online survey was administered to U.S. users of the Amazon “Mechanical Turk” website. Participants were asked (...) to answer questions regarding a series of vignettes depicting different sorts of deception in medical care, as well as a question regarding their general attitudes toward truth-telling. Results: Of the 200 respondents, the majority found the use of placebos in different contexts to be acceptable following partial disclosure but found it to be unacceptable if it involved outright lying. Also, 55.5% of respondents supported the use of sham surgery in clinical research, although 55% claimed that it would be unacceptable to deceive patients in this research, even if this would improve the quality of the data from the study. Respondents supported fully informing patients about distressing medical information in different contexts, especially when the patient is suffering from a chronic condition. In addition, 42.5% of respondents believed that it is worse to deceive someone by providing the person with false information than it is to do so by giving the person true information that is likely to lead them to form a false belief, without telling them other important information that shows it to be false. However, 41.5% believed that the two methods of deception were morally equivalent. Conclusions: Respondents believed that some forms of deception were acceptable in some circumstances. While the majority of our respondents opposed outright lying in medical contexts, they were prepared to support partial disclosure and the use of placebos when it is in the patient's interests or when it is what the person would want. These results support the position that physicians should be allowed a greater degree of authority to make a professional judgment about whether deception might be morally warranted by the circumstances, provided that it doesn't involve outright lying. (shrink)

Is there ever any reason for a doctor to lie to a patient? In this paper, we critically review the literature on lying to patients and challenge the common notion that while lying is unacceptable, a related entity--'benevolent deception' is defensible. Further, we outline a rare circumstance when treating psychotic patients where lying to the patient is justified. This circumstance is illustrated by a clinical vignette.

This article examines the difficulties encountered in teaching professionalism to medical students in the current social and political climate where economic considerations take top priority in health care decision making. The conflict between the commitment to advocate at all times the interests of one’s patients over one’s own interests is discussed. With personal, institutional, tech industry, pharmaceutical industry, and third-party payer financial imperatives that stand between patients and the delivery of health care, this article investigates how medical ethics instructors are (...) to teach professionalism in a responsible way that does not avoid dealing with the principle of justice. (shrink)