大学英语（第四册）复习（原文及全文翻译）——Unit 5 - TO LIE OR NOT TOLIE—THE DOCTOR‘S DILEMMA（撒谎还是不撒谎——医生的难题）

2024-05-10 09:20:29

Unit 5 - To Lie or Not to Lie--The Doctor's Dilemma

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

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 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 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."

参考译文——撒谎还是不撒谎——医生的难题

医生可以对病人撒谎吗？医生应该告诉病人他已经病入膏肓了吗？这些问题看起来很简单，但是要给出令人满意的回答却并不那么简单。

撒谎还是不撒谎——医生的难题

西塞拉·博克

为了对病人有好，为了加快病人康复或不让病人知道死亡的来临，医生到底该不该撒谎？医疗行业与法律、政府及其他行业一样，往往显得对诚实与否的问题不那么看重，要紧的倒是另外的一些事情，譬如，应设法避免可怕的消息造成的打击，或是应考虑恪守保密的诺言，或是需要揭露腐败行为或促进公众利益等。

举例说吧。一个46岁的男子，在与家人外出度假之前进行常规体格检查，虽然他自我感觉良好，但医生发现他患了某种癌症，6个月内就会死去。这时，医生该怎么对他讲呢？是不是最好对他讲实话？要是他问起检查结果，医生该不该否认他得了病？该不该将病情的严重性缩小到最低限度？该不该将真情至少隐瞒到他全家度假之后？

医生们常常面临这样的非常紧迫的选择。他们不时认为，为了病人自身的利益，撒谎很有必要，在他们看来，这种谎言与利己的谎言截然不同。

研究结果表明，大多数医生深信身患重病的人不想知道他们的真实病情，如果将真情相告，则有可能使他们完全失去希望，结果使他们恢复得更慢或恶化得更快，甚至会自寻短见。正如一位内科医生写道："我们这个职业，传统上恪守一条信条，那就是：‘尽可能不造成伤害’，这一信条胜过为讲真话而讲真话的美德"。

有了这样一个指导原则，一些医生可能渐渐习惯于采用他们认为对病人很可能有益而"无害"的骗人做法。他们可能开出无数帖安慰剂，说一些没有事实根据的打气的话，并歪曲严重的病情，对那些患有不治之症和濒临死亡的病人，则尤其如此。

然而，现在开始有人提出证据，说明这种欺骗旨在给病人带来好处的说法是虚幻的。研究结果表明，与许多医生的想法相反，绝大多数病人确实想知道真实情况，甚至是严重的病情。当他们了解到医生没有对他们讲真话的时候，他们感到自己被玩弄了。我们还获悉，将真实情况妥当地告诉病人，能帮助他们与病魔作斗争，有助于他们更好地忍受疼痛，减少用药，甚至在手术后更快地康复。

谎言不仅不能提供鼓吹“仁慈”而欺骗的人们所希望的那种“帮助”，它还侵犯了病人的个人自由，使他们不能对有关自己健康的问题作出明达的选择，包括要不要就医这一首要的选择。我们越来越意识到，病人发病期间，在不知病情或未被如实地告知病情的情况下，他们会遭到什么样的不幸。

特别是濒临死亡的病人——他们最易受骗也最会被人蒙在鼓里——因此而不能作出临终前的种种有关抉择: 是否要住进医院，或进行手术，在何处与何人度过所剩下的一点时间，以及如何处理完自己的事务而后与世长辞。

谎言也伤害说谎的人，损害他们的诚实，并最终损害他们的信誉。谎言还伤害他们的同事。由于病人怀疑有欺骗行为，许多对病人十分开诚布公的医生的工作也因此受到影响。病人的不信任使医疗诉讼案增多，造成医生避免风险的“防御性诊治”增多，而这些又进而有损于整个医疗事业。

剧烈的冲突正在出现。病人开始学会催问真实情况。根据病人应享有的权利的规定，医生应将病情和可供选择的治疗方案通告病人。许多医生尽可能向病人提供这些情况。然而，即使在对病人的权益考虑得最周到的医院里，信奉“仁慈”而欺骗的医生们继续他们传统的古老做法。同事们也许不赞同，但避免公开表示反对。护士们对不得不日复一日地参与欺骗病人的做法也许深恶痛绝，但要抵制却感到无能为力。

及时对这个问题进行公开辩论非常必要。不仅在医疗业，而且在其他行业，从业者不断发现，自己常处于似乎不采用欺骗手段就无法避免严重后果的困难处境。但是公众完全有理由对职业性欺骗保持警惕，因为这种做法特别容易变得根深蒂固，蔓延滋长，并损害信任。无论医疗界、法律界、政府机构还是社会科学界，都不应从“不知者，不为所害”这句老话中得到丝毫慰藉。

参考资料：

1. http://www.kekenet.com/menu/200602/3939.shtml

2. http://www.kekenet.com/daxue/201610/463224.shtml

大学英语（第四册）复习（原文及全文翻译）——Unit 5 - TO LIE OR NOT TOLIE—THE DOCTOR‘S DILEMMA（撒谎还是不撒谎——医生的难题）相关推荐

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