On Lying

The following is a paper I wrote for my medical ethics class. The topic is lying. I had about 20 footnotes, but a simple copy-paste action won't carry those over, so, I'm not claiming to be original here or anything. 

In this paper I will argue that lying to a patient is wrong because lying simpliciter is always wrong. This will be distinguished from other acts, such as reservation and deceit, in which the patient does not receive the truth but may be permissible. Cases will be considered which it may seem beneficial to lie to the patient and to lie for the patient. I will be drawing from St. Thomas Aquinas and other philosophers that interact with the Thomist tradition. 

I begin with the assumption that man is a rational animal. That man is a kind of animal is not controversial, for the whole field of medical science deals with the reality of that animality, and how to treat it. That man is also rational also seems to be uncontroversial as shown by the medical fields concern for autonomy. Autonomy presupposes the use of rational powers to exercise control over oneself. The safeguarding of autonomy usually relates to ensuring that ones rational powers are properly intact, thus further demonstrating the rational nature of man. Man may be more than this, but for our present purposes, we can say he is at least this. 

Given this nature, how is one to be treated? It seems true that how one ought to be treated is according to one’s nature. For example, Michael J. Sandel writes, “...to cure or prevent illness or restore the injured to health does not desecrate nature but honors it.” (Sandel 57). To cure implies there is a deficiency, but in order for there to be a deficiency there must be some standard it fails to meet. To cure an illness means that one is not well, but to be well presupposes a way one is to be. To be injured means ones cannot properly do a function, but this presupposes there is a way we are supposed to function. Health cannot be restored if there is not some universal way health looks like. Sandel uses this kind of language all throughout his work, such as his use of the phrase “memory disorder” (Sandel 52). If memory function is disordered, this presupposes there is a proper order or function to them. It seems pretty commonsensical that this presupposition or this standard is human nature. If human nature is the standard, then anything contrary to that standard is incorrect and needs to be fixed. This is all presupposed in the medical terminology.

While this may be true about the body, is it true about the intellect? I use intellect to mean the same thing as mind and rationality, and possibly soul. There are distinctions between them, but for simplicity sake I just mean the thinking part of you. What would be the end goal of the intellect? It seems as though that (one of) the end goals of the intellect is the discovery and apprehension of truth. To assert the contrary would lead to certain absurdities. We often say that someone who used their intellect to solve a math problem and got the wrong answer has thereby expressed a deficiency in its use. But if the intellect is not oriented towards truth, why think he needs correcting? Suppose someone had nothing but incorrect beliefs. Would we say he has used his intellect well? Even if it were completely out of his control, say by a Cartesian demon, we would recognize that his intellect has been fooled, and it’s been fooled because it grasped what it thought was true, which tells us that we think the intellect is for the truth. Finally, in discussions about autonomy, we worry about the exercise of the will to make a correct choice. But will is moved by the intellect, thus is only as good as what the intellect presents to the will. So, there is a corresponding goodness between the two. If the intellect grasps the truth better, his choices can become more free and more wise. You cannot be autonomous if you are acting on false beliefs. Autonomy depends on an intellect that is oriented towards truth.

So, man is a rational animal, and medicine is supposed to treat man with reference to his nature and make him more excellent in accordance to it. 

Given these considerations, why would lying be wrong? St. Thomas tells us when he writes in his Summa Theologiae: 

“A moral act takes its species from two things, its object, and its end: for the end is the object of the will, which is the first mover in moral acts. … the essential notion of a lie is taken from formal falsehood, from the fact namely, that a person intends to say what is false; wherefore also the word ‘mendacium’ [lie] is derived from its being in opposition to the ‘mind.’ … Therefore it is evident that lying is directly an formally opposed to the virtue of truth.” 

In layman's terms, there are two considerations in determining moral acts. For our argument we will focus on just the end, for St. Thomas calls this the first mover in moral acts, which means it is more fundamental or formal to the act. So, what does it mean to be formally false? It means that it is what the communicator believes to be false, even if what he communicates is accidentally true. It should be emphasized is that what determines a lie is not its truth value, which only focuses on the statement, but on the condition of the subject, and the status of subjects is what we are concerned with. The argument can thus be summed up:

1) Going contrary to the nature of a thing is immoral

2) Lying goes contrary to the nature of the communicative intellect

3) So lying is immoral

Premise 1 stands on relatively safe grounds as it is the working assumption of much of medical ethics and practice. To question this would also have to address how to rethink the assumptions deeply rooted in medical ethics and practice, and that’s too large of a task for this paper. Premise 2 may be intuitively true initially, but counterexamples are not hard to think up. Let us consider some scenarios. 

A doctor walks into an elevator and sees a colleague. “How are you?” she asks. “Fine, thank you” comes the response. What the doctor doesn’t know is that her colleague’s wife just cheated on him and is taking the kids in a divorce. Obviously, he is not doing fine. Has the doctor been lied to? There is a temptation to say “yes”, and this doesn’t seem immoral, so not all lying is immoral. But this ignores the context. We understand that in certain contexts, we don’t take the responses literally. When we go see a movie, for example, we know that Ian McKellan doesn’t really believe he is Gandalf, and so any statement he utters we don’t take to really signify what he has in mind. When the doctor says he is doing fine, there is a contextual understanding that his answer is not meant to be taken literally or as signifying what is truly in mind. It’s just a social nicety. Since lying is to go contrary to what is in mind, and saying, “I’m fine” is not meant to be taken to signify what is in mind, no lie has occurred. In another context, say if the same doctor were to walk into a room with her patient and asked, “How are you?,” we do expect there to be a real signification of what the patient has in mind, and so the answer, “I’m fine” would be a lie, and obviously so since he wouldn’t be there in the first place. 

Another common counter-example is something like a Jew-seeking Nazi, which I will revise to fit more common medical contexts? Suppose a doctor tests his patience for an STD, and it comes out positive. Being a family doctor, he knows them all pretty well, and his patient confides in him, “Doctor, if my wife asks me if I am here, please don’t tell her I am. She is suspecting I am cheating, and if she finds out I have an STD, she will divorce me.” The wife shortly thereafter shows up, demanding to know if her husband is there. The doctor clearly has a duty to his patient to keep as much information as confidential as possible, but he has been asked point blank, “Is my husband here?” Any hesitation on his part will also signal to her that he is. Does St. Thomas make any exception or qualification here? Some philosophers sympathetic to St. Thomas do not think he does, but believe he is simply wrong on the matter. Some Thomists themselves think that such hard cases do make for an exception, and intuitively so. A common appeal is made to “the right to know” qualification that lying is only wrong when you lie to someone who has the right to know the truth. The wife has no right to know who the doctor is seeing at that moment, and so lying to her isn’t wrong. Likewise in the elevator and patient case, the colleague in the elevator does not have a duty to tell the doctor the truth because the doctor had no right to know, while the doctor arguably does have a right to know with the patient. 

Let’s take note of the structure of the argument. It seems to be constructed as a dilemma, where on one horn, you have to bite the bullet and say you cannot lie to the wife, a hard pill for many to swallow, especially since the doctor has a positive duty to his patient, or else take the second horn give up the position and say lies are not intrinsically immoral. But the first horn is ambiguous. To say that you cannot lie does not entail that you have to positively tell the truth. You could have mental reservations and distract the wife, which is easier to do than to admit you are treating her husband. A mental reservation may be something like, “I haven’t seen your husband here for some time.” The goal with this answer is that you are saying something that is technically true and thus not contrary to any belief in mind, but it is said in such a way that you know will probably lead the wife to mean something else. Not seeing the husband “for some time” could mean anything from one second to one year and beyond. So you could mean, “I haven’t seen your husband in five minutes” and have the wife be on her way. Or you could mean “here” to be defined as the room in which both the doctor and wife are standing in, but the husband is not. Perhaps the doctor only sees patients in the medical rooms and not the lobby, and so what he is saying truly signifies what he has in mind, and can once again send the wife on her way. So we see that the horn of the argument is split and we have another, easier, option to choose from. 

Nonetheless, some Thomistic philosophers like Peter Kreeft will say such an intuition tells us it is positively good to lie. And this would be explained by the “right to know” qualification that Janet Smith and others appeal to. Is the “right to know” qualification correct? Not plausibly so for it runs into certain absurdities. For example, if you were to swear an oath that you were not hiding the husband, then you would be perjuring yourself. But perjury is also seen as wrong. What does this mean for perjury? Do we redefine it? But how since the power of an oath, which calls God as a witness, to tell the truth is now gone so long as we use the “right to know” stratagem? Do we throw it out all together? So, you perjure yourself when doing the right thing, which seems counter intuitive if not outright contradictory as you are swearing to God that you are telling the truth when you are not. Another absurdity that it leads to is that it makes it impossible to lie. To make this clear, suppose in the cheating husband scenario, the doctor actually tells her that her husband is there. She has no right to know whether her husband is there or not. Telling her that he is not there wouldn’t violate the lying conditions, but neither would telling her that her husband is in fact there violate the lying conditions. So lies are impossible on this view, a very strange consequence, and surely you can’t be held morally culpable for doing something you had no choice over.

Consider the last scenario, in which a patient is half awake from anesthesia taken during surgery. As nurses are rolling him into his room, he looks up at one of the nurses and asks, “Are we going to Disneyland?” The amused nurse answers, “No” which then causes the patient to sob in uncontrollable sadness and then falls back into unconsciousness. A moment later he regains consciousness, and again asks, “Are we going to Disneyland?” apparently unaware he just asked the same question. The nurse, not wanting to evoke the same response and cause unnecessary emotional distress, answers differently and replies, “Yeah, Mickey is excited to see you in just a minute.” The patient then slips back into unconsciousness and doesn’t remember the episode. Has the nurse lied? The temptation from what I’ve said so far is to say “yes”, but not so fast. Take two examples. Your dog always chews your shoes and this enrages you. Nonetheless, after a moment of puppy eyes, you call him, “Such a good boy!” He is not a good boy, and you know he’s not. Now consider HAL, the computer from 2000: A Space Odyssey. As you make your way to shut HAL down, HAL asks what your plans are. Is it possible for you to lie to HAL? Is it possible to lie to your dog? It seems as though we want to say no, it’s not possible to lie to a computer or dog, but why? If lying is a disorder of signification as St. Thomas says, and signs have to be interpreted by persons, then it seems like who we are lying to requires that they be persons. You can’t lie to your dog or computer, even if you tried, as they are not receptors of signs. In the case of a patient, then, who is not fully cognizant or not in the right frame of mind to properly receive signs, it may not be possible to lie to patients in such conditions. So the nurse does not lie by telling her dazed patient that he is going to Disneyland. 

I have shown that all lying as such is always wrong. I cited St. Thomas Aquinas to that effect, and considered various philosophers within the Thomistic tradition on the issue of lying. I distinguished between lying, reservation, and what lies outside the criteria for lying that allows doctors some breathing space to tell their patients something other than what they believe to be true.