First published 2015 by Ashgate Publishing
Published 2016 by Routledge
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Copyright Sylvie Fainzang 2015
Sylvie Fainzang has asserted her right under the Copyright, Designs and Patents Act, 1988, to be identified as the author of this work.
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This book was first published in French by the Presses Universitaires de France in 2006, under the title: La relation mdecins-malades: information et mensonge. It has been translated from French by Jenefer Bonczyk.
British Library Cataloguing in Publication Data
A catalogue record for this book is available from the British Library.
The Library of Congress has cataloged the printed edition as follows:
Fainzang, Sylvie, 1954, author.
An anthropology of lying : information in the doctorpatient relationship / by Sylvie Fainzang.
p. ; cm.
Includes bibliographical references and index.
ISBN 978-1-4724-5602-1 (hardback)ISBN 978-1-3155-6675-7 (ebook)ISBN 978-1-3171-8207-8 (epub)
I. Title.
[DNLM: 1. PhysicianPatient Relations. 2. Truth Disclosure. 3. Deception. 4. Ethics, Professional. 5. Patient Rights. W 62]
R727.3
610.696dc23
2014037347
ISBN 9781472456021 (hbk)
ISBN 9781315566757 (ebk-PDF)
ISBN 9781317182078 (ebk-ePUB)
Introduction
The Cretan philosopher Epimenides says: All Cretans are liars. If he is telling the truth then he is himself a liar since he is Cretan. Therefore he is not telling the truth. And so he is himself a liar. Therefore he is telling the truth. Consequently, Cretans are not liars at all. And so it follows that Epimenides is not a liar either. Therefore he lied
(The liar paradox, imagined by Euclid)
It is pertinent today to take an interest in the issue of information since our times are characterised by its glorification, and show signs of becoming information-obsessed. This issue is also frequently discussed within the framework of the doctorpatient relationship. However, it is less common to investigate the true nature of this information and its links with truth in particular. But it is more problematic, even totally irreverential, to tackle a subject such as lying and consider it as a social phenomenon, especially when choosing to examine both the lies doctors tell patients and those patients tell doctors, insisting on studying them in the same anthropological terms. Lying is however common practice within this relationship even though each protagonist should be conveying information to the other in order to obtain optimal care. And so, what is the place of lying within the doctorpatient relationship and within information exchanges between actors? What is the nature of the information patients receive concerning their illness, and what is the nature of the information they hope for? How is this quest for information carried out in the context of the doctorpatient relationship, and how is the information conveyed? How do patients perceive this information and the way in which it is given in the context of their relationship with the doctors? What role does information play in their therapeutic choices? Such are the questions guiding this research conducted in France, based on observation of the disparity, or even the contradiction, between the discourse of patients who complain they are not being informed about their condition, and the discourse of doctors who claim that patients do not want to know of their true condition. The twin aims of this research are to expose the conditions in which patients are informed and to understand what is being played out inside the doctorpatient relationship in terms of patient information. In other words, the objective is to gauge both the perception and the reality of the relationships individuals maintain with medical authority. The information in question partly concerns how the diagnosis, or the prognosis, is conveyed, but it also relates to the effects, risks and benefits of treatments. It will thus be examined on these multiple levels.
The information that patients receive concerning their affliction and their treatment is one of the central issues in the debate surrounding the position of patients in the healthcare system and in the therapeutic relationship. But this question is generally asked in ethical terms and many works take it as their object precisely in order to defend a certain position. The authors discussing patient information tend to highlight the ethical questions raised by formulating a prognosis or by asking patients to give consent when they do not possess sufficient information to make their decision. This however is not the aim of this work. Here, the perspective is that of the social sciences. In other words, the purpose is to analyse situations without inferring a normative position.
The issue of information revolves primarily around that of truth. Medical literature abounds with commentaries on the theme of truth which investigate the question of how to decide whether to tell the patient the truth or not. Some authors have shown that for certain pathologies such as cancer (for example Saillant 1988), the problem goes beyond the question of whether or not to tell the truth because there is great uncertainty in knowledge in the domain. However, as we will see, although this uncertainty is indeed an obstacle to truth and, above all, an argument for doctors to justify denying their patients the truth, this is only one aspect of the much bigger issue of information provision. Thus, the issue of truth should be examined in a comprehensive but also extensive manner. The notion of truth, for which Fletcher (1979) distinguished between logical truth (accuracy) and moral truth (veracity), is clearly connected to the notion of lying. According to Fletcher, logical truth is the correspondence between verbal expression and the problem to which this expression refers, whereas moral truth is the correspondence between the expression given to our thought and the thought itself. Logical truth is thus the truth as we know it: moral truth is the truth corresponding to what we believe to be true. Here, it is the second meaning that interests us: that which the liar believes to be true.
The use of the term lie in this work is deliberate, since it does not only apply to a truth not told or to so-called lying by omission, but to the possible communication of false information. Simmel (1991) showed that social relationships involve a certain degree of reciprocal dissimulation. In his view, what distinguishes a lie is not that the person being duped has a false idea of reality since this is something that a lie shares with a mistake but that the person being lied to is misled about the liars opinion.
