               Unit 5

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 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: "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 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 "help" 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 "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 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, "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 

    benefit
vt. do good to 

    recovery 
n.  the process or fact of getting back to a former state of good health; the state of recovering or being recoverd Ȭ

    conceal 
vt. hide, keep from being seen or known 

    line
n.  a business, profession, trade, etc. ҵ

    dwarf
vt. cause to appear small by comparison ʹСʹμ
n. a person, animal, or plant of much less than the usual size ССĶֲ

    shelter
vi. take shelter; find protection 
vt. provide shelter for; protect ڱΣӻ

    brutal
a.  cruel, severe

    uphold
vt. support ֧ţά

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

    expose
vt. disclose; leave uncovered or unprotected ¶¶

    corruption
n.  dishonesty; immoral behaviour °ܻ

    promote
vt. help to grow or develop; raise in rank, condition, or importance ٽƽ

    checkup
n.  a general medical examination

    minimize
vt. reduce to the smallest possible amount or degree

    gravity
n.  the quality of being serious critical 

    confront
vt. meet face to face; oppose ¸ҵأԣԿ

    urgently 
ad. in an urgent manner أȵ
    urgent  a.

    self-serving
a.  serving one's own interests; seeking advantage for oneself ѵ

    recover 
vi. get well; get back to a normal condition

   deteriorate
v. (cause to ) become worse ʹ

    suicide
n.  the act of killing oneself

    physician 
n.  a doctor of medicine  ڿҽ

    traditionally 
ad. by tradition; in a traditional manner

    precept
n.  a rule of moral conduct; maxim ɣ

    precept
vt. rise above or go beyond the limits of; surpass Խ

    virtue
n. goodness or moral excellence; a good quality £ŵ

    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 ο

    warrant 
vt. justify; authorize; guarantee ʹУɣȨ

    distort
vt. give a false account of; twist out of the usual shape Ū

    grave
a.  serious; requiring careful consideration صģ

    incurably 
ad. beyond cure

    illusory
a.  deceptive and unreal; based on an illusion õ

    deception
n.  deceiving or being deceived; a trick intended ot deceive ƭ

    document 
vt. prove or support with documents ļ֤

    contrary
a.  completely different or wholly opposed ෴ģԿ

    overwhelming
a.  too many, too great, or too much to be resisted Ʋɵģѹ֮Ƶ

    betray 
vt. be unfaithful to; deceive 
    
    truthful
a.  true

    humanely 
ad. tenderly, kind-heartedly ʰأ˵

    tolerate
vt. allow or endure with protest 

    advocate
n.  person who speaks for an idea, way of life, etc. ӵߣ

    benevolent
a.  intending or showing good will, kindly, friendly ʴȵ

    invade 
vt. enter (a country) with armed forces in order to attack; violate, interfere with ַ

    autonomy
n.  (the right of) self-government; freedom to determine one's own actions, behavior, etc. ΣȨ

    render
vt. cause to be

    informed
a.  having knowledge or information; having and using suitable knowledge ˽ģмʶ

    concerning
prep. about, with regard to 

    increasingly
ad. more and more all time

    befall( befell, befallen)
vt. (use. sth. bad ) happen to (sb.) ٵͷ

    integrity
n.  honesty or sincerity; wholeness ʵֱ

    credibility
n.  the quality of being believable; trustworthiness ɿԣ

    colleague
n.  an associate; fellow worker or member of a profession or organization ͬ

    suspicion
n.  doubt; mistrust 

    deceit
n.  deception; a dishonest trick ƭ

    undercut
vt. undermine; weaken ƻ

    scrupulously
ad. carefully; conscientiously һ˿

    spiral 
n.  a curved shape which winds round; a continuous and expanding increase or decrease Σ½

    lawsuit
n.  a noncriminal case in a court of law ϣ

    injure
vt. cause physical harm to; damage

    arise (arose)
vi. move or go upward; come into existence 
   
    bill
n.  鰸˵

    alternative
n.  a choice between two or more things; any of the things to be chosen 񣻿ɹѡĶ

    treatment
n.  a substance or method used in treating someone medically ƣƷ

    eloquent
a.  having the power of expressing one's feeling or thoughts with grace and force ۱

    disapprove
vt. consider not good or not suitable; have or express an opinion against ޳

    refrain
vi. hold oneself back; keep oneself (from doing sth.) ס

    object
vi. be against sth. or sb. 
 
   objection n.

    bitterly 
ad. sharply severely

    deceive
vt. cause (sb.) to believe sth. that is false ƭ

    debate
vt. argue about (sth.) in an effort to persuade other people 

    issue
n.  a question that arises for discussion ⣻

    practitioner
n.  a professional man, esp. in medicine or in law ҵߣָҽʦȣ

    consequence
n.  result; importance Ҫ

    avoidable 
a.  that can be prevented from happening

    wary
a.  cautious; in the habit of looking out for possible danger or trouble ģ

    erode
vt. wear away; eat into ʴ

    saying 
n.  a well-known wise statement; proverb ԣ

         Phrases & Expressions
  go on (a trip, vacation) 
  depart for the purpose of 

  at times
  occasionally; now and then ʱ

  in one's eyes
  in one's opinion 

  for one's (own) sake
  for one's own benefit ΪĳԼ

  slip into 
  fall into; enter (esp. through carelessness) 

  contrary to 
  opposite to; despite

  in the first place
  firstly

  in the course of during
  during

  in the dark
  uninformed; ignorant ֪飬ڹ

  bring to a close
  end ֹ

  take leave (of)
  say goodbye (to)

  in the long run 
  in the end; ultimately ӳԶĹ۵㿴

  go to great lengths
  do anything possible, however dangerous, unpleasant, wicked, etc. 

  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.)


 
    
