Question 1: There seem cases in which it is permissible for physicians to deceive and perhaps outright lie to patients. For example, rather than prescribe pharmaceutical drugs which have various side effects, physicians sometimes prescribe placebos (sugar pills). Placebos are sometimes effective treatment options, and they lack serious side effects. Note, however, it also seems plausible that for a given patient to consent to a treatment, providers should at least honestly convey information about that treatment to the patient. It is further plausible though that the efficacy of placebos is tied to patient ignorance about their being prescribed. These plausible commitments seem in tension. We can formulate this into an argument:

(1)   It is permissible for physicians to prescribe placebos as treatment for patients in some cases

(2)   If (1), then it is permissible for physicians to deceive or outright lie to patients in some cases

(3)   Hence, it is permissible for physicians to deceive or outright lie to patients in some cases

(4)   In acquiring patient consent for a treatment, it is impermissible for a physician to deceive or outright lie to a patient

(5)   All treatments prescribed by physicians require patient consent

(6)   If (4) and (5), then it is impermissible for a physician to deceive or outright lie to a patient about a given treatment

(7)   Hence, it is impermissible for a physician to deceive or outright lie to a patient about a given treatment

(8)   Hence, it is both permissible and impermissible for physicians to deceive or outright lie to patients about a given treatment

This argument is valid. That means that if the premises (1)-(7) are true, then the conclusion (8) must be true. Validity is a matter of form, or logic. This isn’t a logic course though. In this course, we’re more interested in whether the above argument is sound. A sound argument is a valid argument with true premises. Your task here is to determine whether this argument is sound. In under 200 words, identify a line you think is false, and provide a counterexample. If you’re correct, then that line is false. If at least one of the remaining lines is false, then the argument is unsound. For your responses, in under 50 words object to counterexamples raised to lines you did not write about, i.e. attempt to counter the counterexamples of other students.

*Hint: Lines (3), (7), and (8) – all of which begin with “Hence” – follow from preceding lines by logic. We won’t be questioning logic in this course, so you can ignore these lines. Focus on the remaining lines.

Response: We might question, (1), (2), (4), (5), or (6). You were only required to object to one, but I’ll take each in turn. Start with (1). To reject this is to assert that:

(NO) It is impermissible for physicians to prescribe placebos as treatment for patients in some cases

That is, it is never ethically ok. This sort of position might be justified by relying on a strong notion of patient autonomy, since such autonomy might require that patients be as informed as is reasonable when making decisions about treatment options. If you think patients must be as informed as possible, then (NO) would follow. That is, one might pose the following objection to line (1):

(i)                 Autonomy requires that patients be as informed as is reasonable when making decisions about a treatment option

(ii)               If (i), then it is impermissible for physicians to prescribe placebos as treatment for patients in some cases

(iii)             Hence, it is impermissible for physicians to prescribe placebos as treatment for patients in some cases

Observe, (i) requires some unpacking, specifically, with respect to what is meant by “reasonable.” You might think, for instance, that it is reasonable for physicians to deceive patients by prescribing them placebos since telling them of the placebos would undermine the purpose of prescribing them. If that’s the case, then (ii) in the above argument would be false. We should strive to be charitable to those we’re arguing against, so let’s for the moment assume the notion of “reasonable” at play rules out physicians prescribing placebos, so that (ii) is true. It nevertheless might count lots of other “reasonable” practices, e.g. autonomy requires patients understand the dangers of a given surgery. Of course, even charitably understood, there are objections to offer to (i). For it’s not clear that autonomy does require patients be as informed as is reasonable, however you spell out “reasonable”. Indeed, in some cases, it seems patients should not be informed at all when making autonomous decisions about treatment options.

Turning to (2), note how difficult this premise is to deny. That premise unpacked is:

If it is permissible for physicians to prescribe placebos as treatment for patients in some cases, then it is permissible for physicians to deceive or outright lie to patients in some cases

Note that (2) has the form "if...then", and it acts like a bridge linking (1) and (3). Objecting to lines that have the form "if...then" is typically approached in two steps. First, you assume the statement between the "if" and the "then" is true. Second, you pose a counterexample to the statement after "then". More specifically, objecting to line (2) involves first assuming it's true that it's permissible for physicians to prescribe placebos to patients for some treatments, then posing a counterexample to show that it's nevertheless impermissible for physicians to deceive or outright lie to patients in some cases.

One might try counterexamples such as the following:

(LATER) Patients who have been lied to may experience psychological/physical harm later if they find out

(LAWSUIT) Physicians may be liable to lawsuits in the event prescribed placebos don't work

With this in mind, claims (LATER) and (LAWSUIT) above can be understood as the following argument against (2): 

(i) Patients who have been lied to may experience psychological/physical harm later if they find out
(ii) Physicians may be liable to lawsuits in the event prescribed placebos don't work
(iii) If (i) and (ii), then it is impermissible for physicians to deceive or outright lie to patients in some cases
(iv) Hence, it is impermissible for physicians to deceive or outright lie to patients in some cases

But so far this in incomplete, since we must add in that we’re assuming (1) is true. That is, the argument in full is:

(i) Patients who have been lied to may experience psychological/physical harm later if they find out
(ii) Physicians may be liable to lawsuits in the event prescribed placebos don't work
(iii) If (i) and (ii), then it is impermissible for physicians to deceive or outright lie to patients in some cases
(iv) Hence, it is impermissible for physicians to deceive or outright lie to patients in some cases
(v) It is permissible for physicians to prescribe placebos as treatment for patients in some cases
(vi) If a physician prescribes placebos as treatment for a patient (in the way typically practiced) then they deceive or outright lie to patients
(vii) Hence, it is permissible for physicians to deceive or outright lie to patients in some cases

Hopefully the problem with this argument is clear: lines (iv) and (vii) contradict each other. In other words, objecting to line (2) in the above argument by appealing to (LATER) and (LAWSUIT) while accepting (1), leads to an inconsistent argument. Inconsistent arguments aren’t ever sound, since the premises can’t all be true at the same time. One of them must be false. Now (e) was stipulated as true since we’re objecting to line (2), and (f) follows conceptually from (e). (iii) strikes me as false. Simply put, the psychological damage and liability issues may be costs worth accepting to do the morally right thing. This shouldn’t be surprising. Doing the right thing is sometimes demanding.

Starting with line (4), I think we find more objectionable premises. Recall, that premise is:

(4) In acquiring patient consent for a treatment, it is impermissible for a physician to deceive or outright lie to a patient

This effectively says that physicians cannot deceive or lie to patients if they’re to have acquired consent. Another way to state this, is by saying ‘If a physician has lied or deceived a patient when attempting to acquire consent, then the physician has acted impermissibly.’ Suppose a physician has lied or deceived a patient in order to acquire consent. Does that mean the physician has in every case acted impermissibly?

Suppose a patient’s partner has just died, and their patient’s physician recognizes and seeks to recommend a needed surgery to the patient. Suppose the physician is confident the patient will reject the surgery if the physician shares a lot of details about the negative consequences. Were the patient in better spirits, however, the physician is sure the patient would consent to the surgery. The physician downplays the negative consequences and the surgery is pursued successfully. Suppose the patient later learns of the negative consequences, and agrees with the physician’s decision to downplay them in the moment. It seems the physician has acted permissibly here. Moreover, this seems to be justified by something like the following principle:

(PAT) A paternalist action undertaken to help a patient is permissible even if the patient does not consent, if, had the patient been thinking clearly, they would’ve agreed to the action

This justifies a range of paternalist actions. For example, this justifies acting on behalf of a patient who is unconscious, or acting on behalf of a child, or someone intoxicated. Indeed, in some of these cases it seems permissible for a physician to lie or deceive patients for their own good. Suppose a patient is intoxicated and resisting badly needed treatment, but a physician is able to calm them down by, say, relaying that the police will not be called despite the patient’s actions, in full knowledge that the police have been called. This seems permissible. If cases like these are permissible, however, then (4) is false. The argument against (4) can be stated as:

(i)                Suppose a physician has lied or deceived a patient when attempting to acquire consent (ii)               Suppose (PAT) is true of the patient
(iii)               If (i) and (ii), then the physician’s action is permissible
(iv) Hence, the physician’s action is permissible

Which is to say if we assume the part of (4) between the “if” and “then” is true, then we can still show that the part of the statement after the “then” is false, since line (v) above is the opposite of that part of the statement. That’s all it takes to show (4) is false.

Consider lastly (5), which asserts that all treatments prescribed by physicians require patient consent. It seems we’ve already provided a counterexample to this line in the preceding discussion, so I will not belabor the point. Similar remarks apply to (6).

In any event, showing any of these premises false would be sufficient to show this argument is unsound.