CHAPTER XVII.
TRUTH IN OUR INTERCOURSE WITH THE SICK.
On the question, whether strict veracity should be adhered to, in every case and under all circumstances, in our intercourse with the sick, there is very great difference of opinion, as well among medical men, as in the community at large. Some are most scrupulously strict in their regard to truth; others, while they are generally so, make some few occasional exceptions in cases of great emergency and necessity; while others still (and I regret to say that they are very numerous) give themselves great latitude in their practice, if they do not in their avowed opinions.
In examining this subject, it is not so much my intention to discuss the abstract question, as to present the many practical considerations that present themselves, illustrating them, so far as is necessary, by facts and cases.
In order to introduce the subject, I will here quote a passage from Percival’s Medical Ethics, which presents the views of those who are in favor of an occasional departure from truth, where the necessity of the case seems to demand it.
“Every practitioner must find himself occasionally in circumstances of very delicate embarrassment, with respect to the contending obligations of veracity and professional duty; and when such trials occur, it will behoove him to act on fixed principles of rectitude, derived from previous information and serious reflection. Perhaps the following brief considerations, by which I have conscientiously endeavored to govern my own conduct, may afford some aid to his decision. Moral truth, in a professional view, has two references; one to the party to whom it is delivered, and another to the individual by whom it is uttered. In the first it is a relative duty, constituting a branch of justice, and may properly be regulated by the divine rule of equity prescribed by our Saviour, to do unto others as we would, all circumstances duly weighed, they should do unto us. In the second it is a relative duty, regarding solely the sincerity, the purity and the probity of the physician himself. To a patient, therefore, perhaps the father of a numerous family, or one whose life is of the highest importance to the community, who makes inquiries, which, if faithfully answered, might prove fatal to him, it would be a gross and unfeeling wrong to reveal the truth. His right to it is suspended, and even annihilated; because its beneficial nature being reversed, it would be deeply injurious to himself, to his family, and to the public. And he has the strongest claim, from the trust reposed in his physician, as well as from the common principle of humanity, to be guarded against whatever would be detrimental to him. In such a situation, therefore, the only point at issue is, whether the practitioner shall sacrifice that delicate sense of veracity, which is so ornamental to, and indeed forms a characteristic excellence of the virtuous man, to this claim of professional justice and social duty. Under such a painful conflict of obligations, a wise and good man must be governed by those which are the most imperious, and will, therefore, generously relinquish any consideration referable only to himself. Let him be careful, however, not to do this but in cases of real emergency, which, happily, seldom occur, and to guard his mind sedulously against the injury it may sustain by such violations of the native love of truth. I shall conclude this long note with the two following very interesting biographical facts. The husband of the celebrated Arria, Cæcinna Pactus, was very dangerously ill. Her son was also sick at the same time, and died. He was a youth of uncommon accomplishments, and fondly beloved by his parents. Arria prepared and conducted his funeral, in such a manner, that her husband remained entirely ignorant of the mournful event which occasioned that solemnity. Pactus often inquired with anxiety about his son, to whom she cheerfully replied, that he had slept well, and was better. But if her tears, too long restrained, were bursting forth, she instantly retired, to give vent to her grief, and when again composed, returned to Pactus with dry eyes and a placid countenance, quitting, as it were, all the tender feelings of the mother at the threshold of her husband’s chamber. Lady Russell’s only son, Wriothesley, Duke of Bedford, died of the small-pox, in May, 1711, in the 31st year of his age. To this affliction succeeded, in November, 1711, the loss of her daughter, the Duchess of Rutland. Lady Russell, after seeing her in the coffin, went to her other daughter, married to the Duke of Devonshire, from whom it was necessary to conceal her grief, she being at that time in childbed likewise; therefore she assumed a cheerful air, and, with astonishing resolution, agreeable to truth, answered her anxious daughter’s inquiries with these words, ‘I have seen your sister out of bed to-day.’”
The falsehood in the two cases related by the author is of the most egregious character, and yet they are fair representations of that kind of deception which many feel authorized to use in the sick room. The equivocation which is practised, it is true, is not always as gross and as labored, but it is as real. And whatever be the degree or kind of deception, the same principles will apply to every case.
The question that presents itself is not, let it be understood, whether the truth shall in any case be withheld, but whether, in doing this, real falsehood is justifiable, in any form, whether direct or indirect, whether palpable or in the shape of equivocation.
And we may also remark, that the question is not, whether those who practice deception upon the sick are guilty of a criminal act. This depends altogether on the motive which prompts it, and it is certainly often done from the best and kindest motives. The question is stripped of all considerations of this nature, and comes before us as a simple practical question—whether there are any cases in which, for the sake of benefitting our fellow men, perhaps even to the saving of life, it is proper to make an exception to the great general law of truth.
The considerations which will bring us to a clear and undoubted decision of this question, are not all to be drawn from the preciousness of the principle of truth, as an unbroken, invariable, and ever-present principle, the soul of all order, and confidence, and happiness, in the wide universe. But the principle of expediency also furnishes us with some considerations that are valuable in confirming our decision, if not in leading us to it. In truth, expediency and right always correspond, and would be seen to do so, if we could always see the end from the beginning.
I will remark upon each of the considerations as I present them.