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(单词翻译:双击或拖选)
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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 conceal1 the approach of death? In medicine as in law, government, and other lines of work, the requirements of honesty often seem dwarfed2 by greater needs: the need to shelter from brutal3 news or to uphold a promise of secrecy4; to expose corruption5 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 deteriorate6 faster, perhaps even commit suicide. As one physician wrote: "Ours is a profession which traditionally has been guided by a precept7 that transcends8 the virtue9 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 deceptive10 practices that they assume will "do no harm" and may well help their patients. They may prescribe innumerable placebos11, sound more encouraging than the facts warrant, and distort grave news, especially to the incurably12 ill and the dying.
But the illusory nature of the benefits such deception13 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 truthful14 information, humanely15 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 benevolent16 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 scrupulously17 hones with their patients; it contributes to the spiral of lawsuits18 and of "defensive19 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 eloquent20 bill of rights, believers in benevolent deception continue their age-old practices. Colleagues may disapprove21 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, practitioners22 may find themselves repeatedly in difficulty where serious consequences seem avoidable only through deception. Yet the public has every reason to be wary23 of professional deception, for such practices are peculiarly likely to become deeply rooted, to spread, and to erode24 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 窘境，进退两难
benefit
vt. do good to 有益于
recovery
n. the process or fact of getting back to a former state of good health; the state of recovering or being recoverd 痊愈；复得
conceal
vt. hide, keep from being seen or known 隐瞒
line
n. a business, profession, trade, etc. 行业
dwarf
vt. cause to appear small by comparison 使矮小，使相形见绌
n. a person, animal, or plant of much less than the usual size 矮小；矮小的动（植）物
shelter
vi. take shelter; find protection 躲避
vt. provide shelter for; protect 掩蔽；庇护
brutal
a. cruel, severe
uphold
vt. support 支撑；维护
secrecy
n. the practice of keeping secrets; the state of being secret
expose
vt. disclose; leave uncovered or unprotected 揭露；暴露
corruption
n. dishonesty; immoral26 behaviour 腐化，道德败坏
promote
vt. help to grow or develop; raise in rank, condition, or importance 促进，推进；提升
checkup
n. a general medical examination
minimize
vt. reduce to the smallest possible amount or degree
gravity
n. the quality of being serious critical 严重性
confront
vt. meet face to face; oppose （勇敢地）面对；对抗
urgently
ad. in an urgent manner 紧急地，急迫地
urgent a.
self-serving
a. serving one's own interests; seeking advantage for oneself 利已的
recover
vi. get well; get back to a normal condition
deteriorate
v. (cause to ) become worse （使）恶化
suicide
n. the act of killing27 oneself
physician
n. a doctor of medicine 内科医生
traditionally
ad. by tradition; in a traditional manner
precept
n. a rule of moral conduct; maxim28 戒律；格言
precept
vt. rise above or go beyond the limits of; surpass 超越
virtue
n. goodness or moral excellence29; a good quality 美德；优点
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 安慰剂
warrant
vt. justify30; authorize31; guarantee 使有（正当）理由；授权（给）；担保
distort
vt. give a false account of; twist out of the usual shape 歪曲；弄歪
grave
a. serious; requiring careful consideration 严重的；严肃的
incurably
ad. beyond cure
illusory
a. deceptive and unreal; based on an illusion 虚幻的
deception
n. deceiving or being deceived; a trick intended ot deceive 欺骗；诡计
document
vt. prove or support with documents 用文件证明
contrary
a. completely different or wholly opposed 相反的；对抗的
overwhelming
a. too many, too great, or too much to be resisted 势不可挡的；压倒之势的
betray
vt. be unfaithful to; deceive 背叛
truthful
a. true
humanely
ad. tenderly, kind-heartedly 仁爱地；人道地
tolerate
vt. allow or endure with protest 容忍
advocate
n. person who speaks for an idea, way of life, etc. 拥护者，倡导者
benevolent
a. intending or showing good will, kindly32, friendly 仁慈的
invade
vt. enter (a country) with armed forces in order to attack; violate, interfere33 with 侵犯
autonomy
n. (the right of) self-government; freedom to determine one's own actions, behavior, etc. 自治（权）；自主
render
vt. cause to be
informed
a. having knowledge or information; having and using suitable knowledge 了解情况的；有见识的
concerning
prep. about, with regard to
increasingly
ad. more and more all time
befall( befell, befallen)
vt. (use. sth. bad ) happen to (sb.) 降临到……头上
integrity
n. honesty or sincerity34; wholeness 诚实，正直；完整
credibility
n. the quality of being believable; trustworthiness 可靠性；可信
colleague
n. an associate; fellow worker or member of a profession or organization 同事
suspicion
n. doubt; mistrust 怀疑
deceit
n. deception; a dishonest trick 欺骗
undercut
vt. undermine; weaken 暗中破坏；削弱
scrupulously
ad. carefully; conscientiously35 一丝不苟地
spiral
n. a curved shape which winds round; a continuous and expanding increase or decrease 螺旋（形）；盘旋上升（或下降）
lawsuit
n. a noncriminal case in a court of law 诉讼（案件）
injure
vt. cause physical harm to; damage
arise (arose)
vi. move or go upward; come into existence 上升；出现
bill
n. 法案；议案；账单
alternative
n. a choice between two or more things; any of the things to be chosen 抉择；可供选择的东西
treatment
n. a substance or method used in treating someone medically 治疗；疗法
eloquent
a. having the power of expressing one's feeling or thoughts with grace and force 雄辩的
disapprove
vt. consider not good or not suitable; have or express an opinion against 不赞成
refrain
vi. hold oneself back; keep oneself (from doing sth.) 忍住；戒除
object
vi. be against sth. or sb. 反对
objection n.
bitterly
ad. sharply severely36
deceive
vt. cause (sb.) to believe sth. that is false 欺骗
debate
vt. argue about (sth.) in an effort to persuade other people 辨论
issue
n. a question that arises for discussion 问题；争端
practitioner
n. a professional man, esp. in medicine or in law 开业者（尤指医生、律师等）
consequence
n. result; importance 后果；重要性
avoidable
a. that can be prevented from happening
wary
a. cautious; in the habit of looking out for possible danger or trouble 谨慎的；谨防的
erode
vt. wear away; eat into 腐蚀
saying
n. a well-known wise statement; proverb 格言；谚语
Phrases & Expressions
go on (a trip, vacation)
depart for the purpose of
at times
occasionally; now and then 间或；有时
in one's eyes
in one's opinion
for one's (own) sake
for one's own benefit 为了某人自己的利益
slip into
fall into; enter (esp. through carelessness) 陷入
contrary to
opposite to; despite
in the first place
firstly
in the course of during
during
in the dark
uninformed; ignorant 不知情，蒙在鼓里
bring to a close
end 结束，终止
take leave (of)
say goodbye (to)
in the long run
in the end; ultimately 从长远的观点看；最终
go to great lengths
do anything possible, however dangerous, unpleasant, wicked, etc. 不遗余力
refrain from
not do , stop
day after day
each day
take a/ one's stand
declare one's position, loyalty37, opinions, etc., and be prepared to fight (for these opinions, etc.)表明立场、意见等
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conceal
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| v.隐藏，隐瞒，隐蔽 | |
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dwarfed
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| vt.（使）显得矮小（dwarf的过去式与过去分词形式） | |
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brutal
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| adj.残忍的，野蛮的，不讲理的 | |
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secrecy
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| n.秘密，保密，隐蔽 | |
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corruption
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| n.腐败，堕落，贪污 | |
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deteriorate
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| v.变坏；恶化；退化 | |
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precept
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| n.戒律；格言 | |
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transcends
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| 超出或超越（经验、信念、描写能力等）的范围( transcend的第三人称单数 )； 优于或胜过… | |
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virtue
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| n.德行，美德；贞操；优点；功效，效力 | |
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deceptive
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| adj.骗人的，造成假象的，靠不住的 | |
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placebos
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| n.（给无实际治疗需要者的）安慰剂( placebo的名词复数 )；安慰物；宽心话；（试验药物用的）无效对照剂 | |
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incurably
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| ad.治不好地 | |
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deception
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| n.欺骗，欺诈；骗局，诡计 | |
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truthful
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| adj.真实的，说实话的，诚实的 | |
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humanely
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| adv.仁慈地；人道地；富人情地；慈悲地 | |
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benevolent
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| adj.仁慈的，乐善好施的 | |
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scrupulously
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| adv.一丝不苟地；小心翼翼地，多顾虑地 | |
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lawsuits
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| n.诉讼( lawsuit的名词复数 ) | |
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defensive
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| adj.防御的；防卫的；防守的 | |
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eloquent
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| adj.雄辩的，口才流利的；明白显示出的 | |
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disapprove
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| v.不赞成，不同意，不批准 | |
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practitioners
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| n.习艺者，实习者( practitioner的名词复数 )；从业者（尤指医师） | |
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wary
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| adj.谨慎的，机警的，小心的 | |
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erode
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| v.侵蚀，腐蚀，使...减少、减弱或消失 | |
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linen
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| n.亚麻布，亚麻线，亚麻制品；adj.亚麻布制的，亚麻的 | |
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immoral
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| adj.不道德的，淫荡的，荒淫的，有伤风化的 | |
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killing
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| n.巨额利润；突然赚大钱，发大财 | |
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maxim
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| n.格言，箴言 | |
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excellence
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| n.优秀，杰出，(pl.)优点，美德 | |
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justify
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| vt.证明…正当(或有理)，为…辩护 | |
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authorize
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| v.授权，委任；批准，认可 | |
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kindly
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| adj.和蔼的，温和的，爽快的；adv.温和地，亲切地 | |
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interfere
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| v.(in)干涉，干预；(with)妨碍，打扰 | |
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sincerity
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| n.真诚，诚意；真实 | |
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conscientiously
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| adv.凭良心地；认真地，负责尽职地；老老实实 | |
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severely
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| adv.严格地；严厉地；非常恶劣地 | |
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loyalty
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| n.忠诚，忠心 | |
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