Friday, August 31, 2012

Telling Lies

As a rabbi, I have never been formally asked if I recommend that people lie to each other instead of telling the truth. What kind of a question would that be anyway? And yet I am nevertheless regularly asked to be party to the dissemination of untruths, which are invariably presented to me not as acts of betrayal or conscious disloyalty to the deceived party, but rather as acts of kindnesses. I am, for example, getting ready to visit someone in the hospital when a relative of the patient, usually an adult child, calls me to let me know just how grim the diagnosis actually is, but also to ask me not to say anything to the patient about how things really are. I understand the concept. No one wants to deprive someone (and especially a loved one) of hope in the future. No one wants to ruin someone’s last weeks or months by making it clear just how unlikely recovery actually is. And no one wants inadvertently to discourage someone who is very ill from following his or her doctor’s suggestions by implying that there’s no point to making any further effort. And yet…isn’t lying wrong? Doesn’t the Torah specifically command us to distance ourselves from falsehood? It does say that, and in those exact words (at Exodus 23:7)…and yet all sorts of people feel entirely justified in telling falsehoods that appear to do no harm, or actually to be beneficial, to the lied-to party. I personally don’t want anyone ever to lie to me about anything, including specifically about my health. But I know that different people feel differently…so I don’t break the confidence entrusted to me. But I never feel quite right saying nothing when I know that that is specifically not how I myself would wish to be treated.

Our tradition justifies the occasional white lie. The Talmud relates a charming debate between the follows of Shammai and the followers of Hillel about just such an issue, for example, in this specific case discussing the reasonableness of praising a bride on her wedding day for her gracefulness and her beauty regardless of how things really may be and concluding that avoiding the humiliation of others is as sacred a commandment as the one forbidding the telling of lies. Another passage that has stayed with me all these years, from a different tractate of the Talmud, records a lesson that in ancient times was attributed to the great sage Samuel. In his opinion, the Talmud teaches, it is permitted—supposing that one is not speaking in court under oath—to tell lies regarding three areas of life, which he designated “book, bed, and hospitality.” All three will be resonant with modern readers. If someone asks intrusive, impertinent questions about one’s intimate life at home with one’s spouse, one has no obligation to answer with the truth merely because the question was posed out loud. And the other two are also easy to seize. The “book” rubric means that if someone asks a scholar if he has mastered a certain tractate of Talmud, the scholar may answer vaguely or even misleadingly if it seems that speaking the truth would be immodest or boastful. And the “hospitality” rubric will also seem reasonable to modern readers: if someone starts quizzing you about the level of gracious hospitality you enjoyed in someone else’s home and you realize that an honest answer is going to be taken as a clarion call for every schnorrer in town to descend on your hosts for their free meal, you are free there too to speak vaguely or even untruthfully about your experience so as not to put your hosts in an uncomfortable or untenable position.

I was reminded of these texts—and also of Rabbi Kassel Abelson’s masterful analysis of them and others like them in his chapter on personal integrity in The Observant Life—when I was reading an article in the newspaper last week that seemed at first highly relevant to these issues. (Now I’m less sure. If you are reading the electronic version of this letter, you can see the article, written by Gina Kolata and published in the New York Times last Saturday, by clicking here.) The issue itself is very interesting and has to do with the kind of genetic research that involves the use of tissue samples taken from living donors, people like you or me who wish to further the work of science and who are prepared to part with some of our cells so that researchers can work on them. It doesn’t seem like a major sacrifice. We do have, after all, something like seventy trillion cells in our bodies. They are not all the same, however—there are more than two hundred “kinds” of cells—and so it is often the case that researchers often need specific types of tissue to carry out their research. We all benefit from scientific discoveries regarding the way the human body works. So why not donate a few cells to help along precisely the kind of research that has in the past led to enormous scientific breakthroughs? A trillion is, after all, a million million. And we have something like seventy trillions of them.

That much seems easy enough to justify. People part with some tissue. They are promised that no one will be in touch, that the donation is the beginning and end of the procedure, that they won’t be pestered with requests for further involvement or with disturbing information gleaned from the research they are supporting. But then, as research techniques have become increasingly more sophisticated, scientists seem regularly to learn things about the donors involved that it seems entirely reasonable that those donors would very much want to know. Unless they don’t. Some of the examples in the article seemed to me to be no-brainers. A woman with a family history of ovarian and breast cancer volunteers some tissue for a study. The doctors in charge know that the donor is so worried about breast cancer and so certain, given her family history, that she will eventually become ill, that she is planning to undergo preventative mastectomies. Surely, when researchers learned that she was not, in fact, carrying her family’s breast cancer gene, they had an obligation to breach the confidentiality clause—the clause that promised her she would not be contacted in the future and burdened with unsolicited, possibly unwanted information—to give her what was clearly going to be very good news.

But other cases are less clear. The article highlighted the case of someone who donated cells for cancer research. In the course of the work, the scientists involved realized that the person involved was probably, but not definitely, HIV-positive, and clearly did not know it. (The individual filled out a form before donating the cells in which that question was specifically asked.) Surely, that person would want to know such an important detail about his or her health. Or is that not that obvious…the person in question could surely have arranged an HIV test if he or she wished to know his or her status! Would it be helpful or cruelly intrusive to force that information on the person involved? It’s not easy to say, and you don’t get to be sure what someone else wants because you feel certain you yourself would, or wouldn’t, want to know. And, given the ability doctors have to maintain the long-term health of individuals infected with the HI virus, even this is a relatively easy issue to talk about. But what if the information had to do with a disease lurking in one’s genetic code that could manifest itself later on and could be fatal…but for which there is no known cure and no known advance therapy. The person would then be burdened with information about which he or she couldn’t do a thing…except spend the rest of his or her life worrying about an uncertain future that either could or could not feature the disease in question. Once the commitment has been formally given not to burden donors with the results of the research they chose to support with the donation of their own tissue, who gets to decide when or if to override that commitment because it seems as though the individual in question would probably (or possibly or almost definitely) want to know? And who mops up the mess if the person who ultimately makes that decision turns out to be completely wrong? (The answer there is clear enough, I think: no one at all, other than the donor now burdened with unwanted bad news, information which cannot be unlearned no matter how profusely the decision-maker apologizes later on.)

Is not telling something to someone the same as lying to them? The halakhah endorses the idea of withholding information from sick people that might make them even sicker. Specifically, the texts talk about the question of telling a very weak person that a close relative has died. The law there is clear: if the doctor in charge feels that that knowledge, by saddening the patient to the point of despair, will even just possibly worsen his or her physical condition, then such information may legitimately be withheld. That seems reasonable enough, yet the decision to withhold information about the patient’s own health—more analogous to the issues raised in the newspaper last week—seems different to me. None of us knows each other that well…and that thought, painful though it may be to contemplate, includes our own parents. Which of us can say with certainty, therefore, that a parent might not have some unfinished business that he or she would want very much to deal with while there might still be time? Or peace to be made with someone that will go unmade if the patient weakens too much further and becomes concomitantly less able clearly to communicate? Who can know another well enough to decide? Or is the solution therefore for no one ever to decide on another’s behalf, for each of us to decide whether or not we wish to know…and then for the rest of the world to honor our decision no matter what?

In the end, none of these questions has a clear answer. The relationship between physician and patient is not precisely the same as the relationship between a clergyperson privy to some detail about a congregant’s health status and that congregant. Nor is either of the above relationships at all like the one between a researcher and the donor of tissue on which that researcher is working, a relationship that almost by definition does not exist at all. In each case, the decision whether to speak or not to speak can only be made based on someone’s best guess about where a patient’s (or a congregant’s or a parent’s) best interests lie. No one can ever be sure. But neither can that lack of finality and certainty serve as an excuse for making no decision at all. These are all thorny issues in need of adjudication. But I only see one clear solution: medical researchers need to make clear to donors in the future that the possibility exists of finding out things about their physical health status that could be very good or very bad news…and to require donors to decide for themselves, and long in advance, whether or not they wish to be contacted in the future. Will that discourage donors from donating? Some, it will. But not all…and perhaps that has to be good enough.

As we approach the High Holiday season, the question at hand is not whether we wish for others to lie to us, but whether we have the moral courage to desist from lying to ourselves, whether we have the inner fortitude to look at ourselves as we truly are, and then to move forward from that kind of honest evaluation of ourselves and our deeds to the point at which we resolve to do better. Lying to the dying is probably only a good idea under very specific conditions when the truth could actually harm, not simply sadden, the patient. Lying to the living is even less often justifiable than that. But lying to ourselves? It’s hard to imagine how that can ever be a good idea, or one that leads to anything other than regret later on.

No comments:

Post a Comment

Note: Only a member of this blog may post a comment.