Truthfulness in the Professional-Patient Relationship: An Incommensurable Problem for Secular Medicine
Stewart Clem, PhD, Assistant Professor, Moral Theology, Aquinas Institute of Theology
There is presently a large and growing body of literature in health care ethics on truthfulness in the professional-patient relationship. With few exceptions, health care ethicists limit their analyses of lying to its practical utility, drawing upon empirical studies about its effect on patient well-being. Some have argued that respect for patient autonomy renders lying impermissible, regardless of its practical utility. But almost entirely absent from this literature are questions about the nature of truth and its relationship to truthfulness. This is unsurprising, given contemporary health care ethicists’ reluctance to engage metaphysical questions. Ignoring these questions, however, does not amount to a ‘neutral’ secular metaphysics; rather, it precludes certain conceptions of the good life and what it means to die a good death.
The argument I develop in this paper proposes that Christian health care organizations and practitioners, insofar as they understand the practice of health care to reflect their religious commitments, have a special stake in being honest with patients, not for instrumental or utilitarian reasons, but because their understanding of reality demands it. While the paper is written from a Christian theological perspective, it has broader implications for the sacred- secular divide in medicine, and it will be of interest to all religious health care ethicists insofar as religions claim to assert truths about ultimate reality.
My paper proceeds from an insight about the colloquial use of terms such as ‘truth’ and ‘lies.’ In the ethics of lying there is an important distinction to be made between truthfulness (a virtue or character trait) and ‘capital-T’ Truth (a set of metaphysical commitments). Thomas Aquinas, in his Summa theologiae, for example, notes that while veritas (truth) and veracitas (truthfulness) are intimately related, they should not be conflated. On this account, it is possible to utter an objectively true statement while telling a lie, and it is possible to utter an objectively false statement while being truthful. Yet, we often refer to false statements as ‘lies’ even if they are spoken by someone who is sincere, especially if we believe the statements to be harmful. This suggests that the value of truthfulness is not limited to sincerity or integrity but also extends to its truth conductivity.
Those who defend the practice of lying to patients, such as Dr. Daniela Lamas in a recent New York Times essay (October 6, 2021), claim that at least in some circumstances a lie is better for the patient than the truth. Or conversely, they claim that telling the truth would be harmful to the patient. But such a claim already rests on metaphysical assumptions. By hiding a terminal diagnosis from a patient, for example, the clinician is deciding that it would be better for the patient to face death unknowingly than to be confronted with the reality of her condition. Against this approach, my paper argues that religious commitments are not extraneous to the morality of lying to patients, but rather that they are constitutive of our practical reasoning.
The argument I develop in this paper proposes that Christian health care organizations and practitioners, insofar as they understand the practice of health care to reflect their religious commitments, have a special stake in being honest with patients, not for instrumental or utilitarian reasons, but because their understanding of reality demands it. While the paper is written from a Christian theological perspective, it has broader implications for the sacred- secular divide in medicine, and it will be of interest to all religious health care ethicists insofar as religions claim to assert truths about ultimate reality.
My paper proceeds from an insight about the colloquial use of terms such as ‘truth’ and ‘lies.’ In the ethics of lying there is an important distinction to be made between truthfulness (a virtue or character trait) and ‘capital-T’ Truth (a set of metaphysical commitments). Thomas Aquinas, in his Summa theologiae, for example, notes that while veritas (truth) and veracitas (truthfulness) are intimately related, they should not be conflated. On this account, it is possible to utter an objectively true statement while telling a lie, and it is possible to utter an objectively false statement while being truthful. Yet, we often refer to false statements as ‘lies’ even if they are spoken by someone who is sincere, especially if we believe the statements to be harmful. This suggests that the value of truthfulness is not limited to sincerity or integrity but also extends to its truth conductivity.
Those who defend the practice of lying to patients, such as Dr. Daniela Lamas in a recent New York Times essay (October 6, 2021), claim that at least in some circumstances a lie is better for the patient than the truth. Or conversely, they claim that telling the truth would be harmful to the patient. But such a claim already rests on metaphysical assumptions. By hiding a terminal diagnosis from a patient, for example, the clinician is deciding that it would be better for the patient to face death unknowingly than to be confronted with the reality of her condition. Against this approach, my paper argues that religious commitments are not extraneous to the morality of lying to patients, but rather that they are constitutive of our practical reasoning.