Truth and the Dying
By J. M. CAMERON • THE Bishop of Leeds has been criticised recently for' some remarks he made to a gathering of nurses. He is widely supposed to have told them that it was their responsibility to inform dying patients of their situation. What Dr. Heenan said was rather different and ran as follows :
It is no part of your duty as .nurses to deceive patients. You should not lie to them or pretend that they are recovering when you know that their condition is likely to prove fatal. Everyone who believes in God—Catholic and non-Catholic, Christian and Jew—has the right to be given the opportunity to prepare for judgement. If a patient is an atheist and does not believe in the after-life he may prefer to be left to die like an animal without spiritual consolation. But a nurse should not deceive believers. Relatives, too, have the right to be told the truth. Their desire to be informed of the true facts must be respected.
(Yorkshire Post, June 24, 1954) No doubt many taxing problems of medical ethics are left undiscussed in this statement; and some of the controversy provoked by the statement has turned on questions as to the relative responsibilities of nurses, doctors and relatives. Many have suggested that to tell a man he is dying is to destroy his happiness and peace of mind and thus to diminish his capacities for enjoyment in the last hours, days or weeks of his life. Others have suggested that where there is life there is hope; and that to tell a man his illness is likely to prove fatal is the surest way to make his death certain. Some religious persons have argued that if one has led a virtuous life one needs no special preparation for death. (This may well be true, but seems irrelevant so far as mans, of us are concerned. Those who take this view do not seem anxious to commit them- selves to a possible corollary of their view : that if one has not led a life of virtue, it is too late to mend on one's death- bed.) Altogether, this has been an interesting and many-sided discussion on a matter ofpermanent importance.
One problem has for the most part been left undiscussed. Has a man a right to know the truth about his condition ? Many Christians will certainly think it prudent he should be told the truth; perhaps all Christians thought this down to the end of the Victorian age. The hedonists who, with an immense assurance that their own view is the plainest common sense, have contributed to the discussion may be right—though it is hard to see how they could show they are right—in thinking that to tell a man the truth will tend to lessen or destroy his remaining opportunities for enjoyment; though against this may be set the interesting comment in a letter from a nurse that in her experience dying patients are often grateful and happy when the truth delivers them from a condition of anxious uncertainty. At this level of argument there is certainly much to be said both for candour and for deceit. But if a man has the right to know the truth about his condition, this kind of argument may be irrelevant. It may, in this or that particular case, be prudent or imprudent, calculated to make him happy or miserable, to tell a dying man the truth about his condition; but if he has a right to know the truth, we must presume that he wishes his right to be respected, unless—as Dr. Heenan hinted might be the case with some atheists—we have reason to think he has expressly renounced his right; and prudential or hedonistic considerations are beside the point.
Questions about ' rights ' are notoriously tricky. The common eighteenth-century view that it is self-evident that men possess certain rights encounters the obvious difficulty that men of equal intelligence and sincerity disagree about them. Rights are not sensible characteristics such as height and pigmentation; nor do they resemble dispositions such as irascibility or sloth. Perhaps it will be sufficient (for the purposes of this discussion) if we say k that expressions asserting rights are condensed assertions of moral rules; and that moral rules are justified, or are often thought to be justified, by statements about human nature, such as that man is a ' person.' an ' end in himself,' and so on. At some point we shall no doubt be driven back upon self-evidence. We shall want to say that it was plainly wrong to push men, women and children into the gas chambers of Auschwitz, burn them and use their ashes as fertiliser for growing cabbages. Plainly it was wrong. And why ? The question may be senseless; but we most of us feel there are answers of a kind, and that among them are statements about human nature and what is due to it.
What is thought due to human nature varies from culture to culture. We see that in this respect our own culture is changing if we reflect, that many who commented on Dr. Heenan's remarks sincerely thought them cruel and odious; and it may be that lb fifty or a hundred years there will be virtual unanimity that we owe it to a man to deceive him about the state of his health, should this be grave. If this is even a possibility, it is surely because we have come to prefer a partial to a complete vision of human life. We turn our gaze from 'the fact of death—the Whispering Glades' of California only caricature an attitude spread widely beyond the United States—finding it trivial or mean or absurd. Death, like sex, is shameful. To speak of death to the dying is like shouting obscenities at an unsophisticated young person.
Two kinds of lying are in question. There is the lie which consists in trivialising the fact of death; and there is the lie which derives from this—the deception of adult and responsible persons about the fact of their dying. The second lie is only possible if we have allowed ourselves to be betrayed into accepting the first. After all, no one blames a dentist who assures the timid patient that ,the operation won't hurt '; for here the matter is trivial.
If we look to our past we find death treated as all of apiece with life, as a completion which can have its own nobility. We may not find the death-bed scenes of the Victorian novels much to our taste; but they reflect a social reality, an approved pattern of dying. John Stuart Mill was no believer; he was even a hedonist of sorts, but his doctor tells us:
Mr. Mill suffered but little . . and yet he learnt from me on
my. arrival the fatal nature of the attack with calmness and resignation.
Tennyson was a man sorely puzzled by death; but we read that he whispered to his doctor, ' Death ? ' and that the doctor bowed his head in affirmation and that Tennyson replied. That's well.' These men may not have met their death like Christians; but they met it like men and were treated by those round them like men, not like dogs or idiots.
Kierkegaard once remarked that Christianity is the perfec- tion of the truly human. The truth of this is vividly brought out by the spectacle of a Christian death. I choose as my example not the death of a saint, but the death of one of the noblest of Englishmen who fell short of sanctity: Dr. Samuel Johnson. Boswell writes :
Johnson, with that native fortitude, which, amidst all his bodily distress and mental sufferings, never forsook him, asked Dr. Brocklesby, as a man in whom he had confidence, to tell him plainly whether he could recover. Give me (said he) a straight answer.' The Doctor having first asked him if he could bear the whole truth, which way soever it might lead, and being answered that he could, declared that, in his opinion, he could not recover without a miracle. ' Then (said Johnson) I will take no more physick, not even my opiates: for I have prayed that 1 may render up my soul to GOD unclouded.'
Is it possible soberly to maintain that such an end to life on the earth is inferior to an end in which a man is first deceived by those around him and then, perhaps dulled by the opiates Johnson refused, left to die in ignorance ? It is not sufficient to reply that most lack Johnson's native fortitude' and Johnson's faith. We are concerned with how men ought to die and with whether or not they are to be given the opportunity to die well. This concerns us all. It is not a problem peculiar to nurses and doctors. Any one of us would think it a breach of sound morals if his bank manager or his government or his wife or the teacher of his children were to deceive him in a matter of importance; and to argue that it was for his own good, that he could not bear the truth, would be to add insult to the injury. Do we think it right and commendable that doctor, nurses and relatives should lie to a man when he stands in the shadow of death ?
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