Deception, intention and clinical practice

Abstract

Regarding the appropriateness of deception in clinical practice, two (apparently conflicting) claims are often emphasised. First, that ‘clinicians should not deceive their patients.’ Second, that deception is sometimes ‘in a patient’s best interest.’ Recently, Hardman has worked towards resolving this conflict by exploring ways in which deceptive and non-deceptive practices extend beyond consideration of patients’ beliefs. In short, some practices only seem deceptive because of the (common) assumption that non-deceptive care is solely aimed at fostering true beliefs. Non-deceptive care, however, relates to patients’ non-doxastic attitudes in important ways as well. As such, Hardman suggests that by focusing on belief alone, we sometimes misidentify non-deceptive care as ‘deceptive’. Further, once we consider patients’ beliefs and non-doxastic attitudes, identifying cases of deception becomes more difficult than it may seem. In this essay, I argue that Hardman’s reasoning contains at least three serious flaws. First, his account of deception is underdeveloped, as it does not state whether deception must be intentional. The problem is that if intention is not required, absurd results follow. Alternatively, if intention is required, then identifying cases of deception will be much easier (in principle) than Hardman suggests. Second, Hardman mischaracterises the ‘inverse’ of deceptive care. Doing so leads to the mistaken conclusion that common conceptions of non-deceptive care are unjustifiably narrow. Third, Hardman fails to adequately separate questions about deception from questions about normativity. By addressing these issues, however, we can preserve some of Hardman’s most important insights, although in a much simpler, more principled way.

Unintentional deception still deceives

“…[1] In an insightful and well-argued response, Colgrove highlights three problems with my account: (i) that my definition of deception is implausible because it does not involve intention; (ii) that my definition of non-deceptive care is too narrow; and (iii) that I conflate questions of deception with questions of normativity. [2] I concede that Colgrove's definition of non-deceptive care is better; although, as Colgrove himself notes, his definition still accommodates instances of clinical care which are non-doxastic and non-deceptive. I also concede that it is important not to conflate questions of deception with questions of normativity.…”

“…To resolve this issue, I propose a modification of my initial definition which does not involve intention but instead involves responsibility: deception in medicine involves being responsible for introducing or sustaining a patient's false or erroneous belief. 2 On these terms, Alex's case involves deception because the physician is responsible for sustaining Alex's false belief that he is fit and healthy by (in this case unintentionally) bringing about misleading evidence to sustain that belief. Whereas Colgrove's diabetes case is classed as non-deceptive because the physician cannot plausibly be held responsible for sustaining the patient's false belief, insofar as they merely made a reasonable statement.…”

“…One could equally argue that misleading (accidental or otherwise) is a mode of deception (such as, for example, lying). 2 A narrower version of this definition is: deception in medicine involves introducing or sustaining a patient's false or erroneous belief by bringing about evidence.…”

Deception in medicine: acupuncturist cases

“…Acupuncturist 1: Acupuncturist Alice tells her patient “Your back pain is caused by the disruption of your vital energy.” Alice believes this to be true, but understands that research supporting this view falls short of the standards required by modern medicine. (Adapted from Hardman1 and Colgrove 2…”

“…Colgrove challenges Hardman’s account of deception, arguing that if deception needn’t be intentional, it would yield absurd implications 2. He asks us consider the following case:…”