![]() Accordingly, lying can be thought of as a normal part of human development (with confirmation that one's thoughts are independent and separate) and may even be adaptive in certain situations. Many historians and philosophers, however, have taken a less definitive position on deception. 6 – 8 Kant's premise was that truth telling is a moral duty 1 and that lies would eventually become self-defeating as people learn that they cannot rely on the word of others. 6 Immanuel Kant argued (eg, by virtue of his categorical imperative) that because we cannot be certain of the consequences of our actions, lying in even the most seemingly justifiable circumstances is wrong. Augustine and divine law, lying is both illegal and immoral it undermines relationships and the will of God. 5 (p297,299)ĭespite a lack of a clear prohibition of lying within such oaths, philosophers have long argued that lying is inappropriate. Give necessary orders with cheerfulness and sincerity, turning his attention away from what is being done to him sometimes reprove sharply and sometimes comfort with solicitude and attention, revealing nothing of the patient's future or present condition, for many patients through this course have taken a turn for the worse. Perform your medical duties calmly and adroitly, concealing most things from the patient while you are attending to him. Intentional deceptions in the doctor-patient relationship can serve as obstacles to effective clinical care and can seem incongruent with the benevolent practice of medicine therefore, it is surprising to find some support for lies in the Hippocratic Decorum: HOW HAS LYING BEEN VIEWED IN A HISTORICAL CONTEXT? Similarly, the conveyance of false information when the individual believes it to be true, as in a dissociative or fugue state, or self-deception through unconscious defense mechanisms in the service of repression or as a manifestation of a personality disorder would generally fall outside this definition. 4 Using this definition, some psychiatric conditions-eg, conversion disorder (with the sudden onset of neurologic symptoms without any physically identifiable explanation) and confabulation (the automatic production of falsehoods to conceal memory gaps)-do not involve lying, as unconscious or uncontrollable motivations underlie symptom production. Verbal strategies of deceit involve the use of denial, distortion, evasiveness, fabrication, irrelevance, nonresponsiveness, and omission. Such behavior includes efforts at both concealment and falsification. This article discusses acts of deception in medical settings and considers the context in which lies are told and how clarification and conflict resolution can occur.Īccording to Ekman, 3 lying is the act of one person intending to mislead another, deliberately, without prior notification of this purpose, and without having been asked by the target. Additionally, doctors and patients are ever more encouraged to serve as partners in clinical care, 2 placing a greater demand on the relationship and on the open exchange of information. Managed care and time constraints add further pressure. Further, information exchanges are increasingly (via e-mail and medical records) electronic fewer face-to-face interactions make communication even more challenging. 1 Such untruths and manipulation of information can damage relationships and compromise clinical care. What doctors reveal, withhold, or distort matters greatly to their patients. Unfortunately, both patients and physicians are often challenged by complicated communications each group withholds, distorts, obfuscates, fabricates, or lies about information that is crucial to the doctor-patient relationship and to effective treatment. ![]() Have you ever lied to your patients or been surprised to learn that one of your patients lied to you? Have you considered it important to learn why lies emerge in the treatment relationship? Have you wondered whether (or how) you should confront such untruths? If you have, then the following discussion should provide the forum for answers to these and other questions related to the exploration, detection, and management of lies in the medical arena.Ĭlinicians realize that making an accurate diagnosis relies on the provision of reliable information by patients and their family members and that timely, astute, and compassionate care depends on effective bidirectional communications (between the patient and the physician).
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