But is that literally as good for a patient in an ICU who really, really needs to not shut up about these things? i mean, in that situation, it would probably occur to me that the nurse might still be lying… but telling a lie like that is still a kind of permission to bother her which “Don’t worry about it” isn’t.
Agreed. One of the things I think is wrong with lying in general is that it can mess up the incentives for behaviours you want to see more of (i.e. a white lie to your friend, claiming to like her awful haircut, doesn’t do anything to help your friend improve her future haircuts.) In my example, I’m lying with respect to my first-order desires, but telling the truth according to my second-order desires. I may first-order want a few more minutes to drink tea and socialize with the other nurses, but I don’t endorse myself wanting that, and I certainly don’t want to encourage my patients to not call me because they’re worried I’m too busy or tired or cranky. I second-order want to encourage the behaviour where my patients call me for all the little things and 90% of the time it’s annoying and stupid but 10% of the time it’s super important.
If I ever had a patient with a rationalist background, maybe I could explain all of that, but maybe not even then; most people aren’t at their best for following complex logic when they’re loopy on drugs or having trouble breathing or whatnot. So I go for the emotional reassurance, because that gets through. Still working on different phrasings, and I don’t always succeed; I was helping out another nurse with her patient who had diarrhea, putting her on the bedpan every half hour, and at one point she fell asleep and pooped in the bed while asleep and then cried with frustration the whole time I changed her, and I wasn’t able to reassure her.
You can expand “Don’t worry about it” to include permission to bother her. “Don’t worry about it—please never give it a second thought if you need me for anything. That’s what I’m here to do.”
I don’t think “This doesn’t bother me” gets parsed literally anyway. In either case what ever you say they are pretty sure it is annoying for you, albeit they do want reassurance that it is not so annoying that you would snap “yes this is annoying!”.
Well, that’s a good idea right there. You could tell them: “Please don’t be embarrassed, and don’t hesitate to call me. You’re in an ICU and it’s very important that you communicate with us, even if it’s just a matter of discomfort. You shouldn’t assume you can tell the difference between something trivial and something serious, or something that requires immediate attention and not.”
I would interpret that as a straightforward confirmation that it was in fact annoying. There would be no resulting awkwardness but it would definitely not make me more likely to speak up again.
To invoke a cheesy meme, I wish I could upvote twice, once for phrasing something that doesn’t involve telling a white lie, and the second time for consciously reinforcing that patient care is a sacred duty.
I would count it as a white lie. It’s literally accurate, but it implies a number of things. Some of those things are correct (you consider it important to care for the patient and be informed of any problems), but some of those things are incorrect (you are not annoyed). It isn’t disqualified as a lie just because you believe that your annoyance is not important.
I don’t think that the nurse is implying that he is not annoyed. Both the patient and the nurse recognise that the ‘crapping the bed’ situation is an annoying one, and the nurse is not denying that. The nurse is simply making it clear that his annoyance is a secondary concern, and that instead the welfare of the patient is the primary concern. The nurse genuinely believes that his own annoyance is relatively less important, and he is conveying that literally to the patient. This is actually the true situation, so I am confused about how you think he is lying, even implicitly.
I don’t think that the nurse is implying that he is not annoyed.
If you go sufficiently upthread, you’ll find that it started with a post by Swimmer963 who is a nurse and is relating her own experience. In particular, she says:
There are certain lies that I tell over and over again, where I’m 99% sure lying is the morally correct … When it’s 4 am and I desperately want to go on break and eat something, none of these things are true.
“Taking care of you is my sacred duty. I care about you. It is important that you tell me if there is something wrong.”
Is precisely something that Swimmer963 could say even though she’s annoyed. She doesn’t have to deny that she’s annoyed, or even imply it. In fact it’s probably futile to try… of course she’s annoyed, and the patient suspects that. That is exactly the motivation for her lie in the first place.
The statement above nevertheless conveys her overall commitment to the patient’s wellbeing, and encourages the patient to understand that “Obviously, my nurse is annoyed about the crap in the bed, but there are more important factors at play here.”
As an extra bonus, I don’t think it’s a lie, hence providing a response to Eliezer’s implied challenge.
On the contrary, her claimed standard response:
“This doesn’t bother me. I’ve got plenty of time. I just want you to be comfortable, that’s my job.”
Contains three lies, none of which will probably even be believed by the patient:
“This doesn’t bother me.”
(Obvious lie.)
“I’ve got plenty of time.”
(Obvious lie.)
“I just want you to be comfortable.”
(True in spirit but obviously literally false—she also wants to eat or sleep or socialise or get out of this room that stinks of crap, etc.)
“That’s my job.”
(The patient knows that, but it’s cold comfort to them and saying it might suggest that’s the only reason the nurse is helping them, which erodes patient-nurse rapport.)
My point is that Swimmer963′s strategy probably doesn’t really achieve her goals, lying or no lying, and in my original post I was suggesting a possible (honest) alternative.
That’s not quite sufficient as it’s the word “sacred” which does the heavy lifting. Saying it’s her duty isn’t particularly meaningful for a nurse—it’s her job, that’s what she is paid to do. She is not doing you a favour, cleaning up shit is right there in her job description.
Well the classic lie in medicine is when a sibling confides in the doctor that he doesn’t want to donate a kidney to his brother or sister and he’s just getting tested out of family pressure. I understand that in such a situation, the doctor will normally lie and say that they ran the tests and the sibling is not a compatible donor.
Actually, regardless of the reason, they just say that “no suitable donor is available.” If pressed, they say they never release potential donors’ medical information to recipients, for confidentiality and to protect donors from coercion.
Actually, regardless of the reason, they just say that “no suitable donor is available.” If pressed, they say they never release potential donors’ medical information to recipients, for confidentiality and to protect donors from coercion.
That’s interesting . . . what happens if the potential donor asks for (and is willing to sign a release) so that his medical information can be released?
Depends. Different countries have different laws governing such. For the most part, if the hospital sees any legal liability at all, they’ll do the standard CYA. Signing waivers / releases often doesn’t do a whole lot, some of your rights you cannot sign away. Regarding your question, with releasing medical information, such waivers shouldn’t be a problem, although the transplant scenario may be a special case.
Regardless of the legalese, transplant doctors typically get to know you quite well, and more information slips out (implicitly and explicitly) than may be allowed by law (HIPAA be damned). Nullum ius sine actione, as they say. If noone complains, noone sues. Bit like driving without seatbelts.
Different countries have different laws governing such
I’m talking about the United States.
Regarding your question, with releasing medical information, such waivers shouldn’t be a problem, although the transplant scenario may be a special case.
This is an interesting situation, after all, a simple utility calculation says that the receiver’s life is worth more than the donor’s annoyance. Then again, we’re getting close the the cases where utilitarianism fails horribly here.
Well I think most people are reasonably comfortable with the idea that every adult should have complete discretion over what—if anything—is done with his organs.
The more interesting question is what to make of people who lie to conceal decisions in this area, especially physicians.
Well I think most people are reasonably comfortable with the idea that every adult should have complete discretion over what—if anything—is done with his organs.
Yes, but what do you mean by “complete discretion”? After all, the donor was in fact willing to go through with it despite the misgivings, i.e., he valued his relationship with his family more then the annoyance of donating.
And while we’re on the subject of the donor’s preferences, note that both seem to score higher than his sibling’s life. Draw your own disturbing conclusions from that.
By that reasoning if there was some situation where he had to sell himself into slavery to save his sibling’s life, similarly disturbing conclusions could be drawn from his refusal to do that.
You’re making an awful lot of assumptions, including the assumption that the person is a utilitarian and that their reasons for not wanting to donate don’t also involve life or considerations that a wide range of people consider as important as life.
Yes, but what do you mean by “complete discretion”?
I mean that a potential donor should be able to decline for pretty much any reason, no matter how trivial or silly.
After all, the donor was in fact willing to go through with it despite the misgivings
I’m not sure who you are talking about here. In the hypothetical I presented, the potential donor was not willing go through with the donation.
And while we’re on the subject of the donor’s preferences, note that both seem to score higher than his sibling’s life. Draw your own disturbing conclusions from that
Disturbing or not, it’s reality. A lot of people would not donate a kidney to save a sibling. Either because they hate their sibling and hope that he or she dies sooner rather than later; or because they are selfish and wouldn’t lift a finger to save a family member; or for some other reason.
Anyway, you keep trying to change the subject away from the issue of lying. Please stop it.
Well, in the example he can decline, he will simply have to deal with the consequences.
Agree, but so what?
So the potential donor still has complete discretion and thus there is no reason for the doctor to lie.
Positive for what?
For compatibility as a donor.
What exactly is the flaw in your view?
Near as I follow your logic, the reason for lying is that the doctor is trying to protect the patient’s right to over what—if anything—is done with his organs. However, as I pointed out that right is not under threat, what is under threat is the patient’s “right” for his decision to have no consequences.
So the potential donor still has complete discretion and thus there is no reason for the doctor to lie.
I disagree. For example, the potential donor might want to lie to spare the feelings of his sibling. Or to forestall family members from getting annoyed at him.
In which case, what would he do if the tests came back positive?
Lie and say he was incompatible. That’s kinda the point of this subthread.
Near as I follow your logic, the reason for lying is that the doctor is trying to protect the patient’s right to over what—if anything—is done with his organs
Not exactly—the reason for the doctor lying is to prevent hurt feelings and family discord.
Sparing somebody’s feelings is a much worse reason for lying than protecting their right to bodily autonomy.
I don’t disagree with you . . . have I suggested otherwise?
I meant what would the donor do if the person refused to lie.
I don’t know, it would be up to the potential donor. But either way he gets to make his decision and nobody in this discussion is disputing that. Agreed?
ETA: Now that I have explained why medical personnel might lie about compatibility, is there any other flaw in your view? At this point, is there anything I have said which you disagree with?
However, as I pointed out that right is not under threat, what is under threat is the patient’s “right” for his decision to have no consequences.
For a consequentialist, having decisions have “consequences” should not be a terminal value. If decisions having consequences cause those decisions to not be made, that is good, but decisions having bad consequences is, in and of itself, bad.
For a consequentialist, having decisions have “consequences” should not be a terminal value.
But it is instrumentally useful if people’s decisions have consequences to the person doing the deciding that are correlated with the net affect of their decision.
Huh? We aren’t discussing the sibling’s decision to give or not give the kidney, we’re discussing the doctor’s decision, given that the sibling isn’t donating the kidney, to tell the patient that the sibling is a match. Are you implying that the doctor should reveal the match, so the patient will pressure the sibling into donating?
How about adding a tiny bit of ambiguity (or evasion of the direct question) and making up for it with more effusiveness, eg, “it’s not only my job but it feels really good to know that I’m helping you so I really want you to bug me about even trivial-seeming things!” All true and all she’s omitting is her immediate annoyance but that is truly secondary, as she points out below about first-order vs second-order desires.
Upvoted for a rare case of lying where I find myself unable to suggest a good alternative way to not lie, even for people with high verbal SAT scores.
“Don’t worry about it.”
Imperatives are often a nice fallback.
But is that literally as good for a patient in an ICU who really, really needs to not shut up about these things? i mean, in that situation, it would probably occur to me that the nurse might still be lying… but telling a lie like that is still a kind of permission to bother her which “Don’t worry about it” isn’t.
Agreed. One of the things I think is wrong with lying in general is that it can mess up the incentives for behaviours you want to see more of (i.e. a white lie to your friend, claiming to like her awful haircut, doesn’t do anything to help your friend improve her future haircuts.) In my example, I’m lying with respect to my first-order desires, but telling the truth according to my second-order desires. I may first-order want a few more minutes to drink tea and socialize with the other nurses, but I don’t endorse myself wanting that, and I certainly don’t want to encourage my patients to not call me because they’re worried I’m too busy or tired or cranky. I second-order want to encourage the behaviour where my patients call me for all the little things and 90% of the time it’s annoying and stupid but 10% of the time it’s super important.
If I ever had a patient with a rationalist background, maybe I could explain all of that, but maybe not even then; most people aren’t at their best for following complex logic when they’re loopy on drugs or having trouble breathing or whatnot. So I go for the emotional reassurance, because that gets through. Still working on different phrasings, and I don’t always succeed; I was helping out another nurse with her patient who had diarrhea, putting her on the bedpan every half hour, and at one point she fell asleep and pooped in the bed while asleep and then cried with frustration the whole time I changed her, and I wasn’t able to reassure her.
You can expand “Don’t worry about it” to include permission to bother her. “Don’t worry about it—please never give it a second thought if you need me for anything. That’s what I’m here to do.”
I don’t think “This doesn’t bother me” gets parsed literally anyway. In either case what ever you say they are pretty sure it is annoying for you, albeit they do want reassurance that it is not so annoying that you would snap “yes this is annoying!”.
Well, that’s a good idea right there. You could tell them: “Please don’t be embarrassed, and don’t hesitate to call me. You’re in an ICU and it’s very important that you communicate with us, even if it’s just a matter of discomfort. You shouldn’t assume you can tell the difference between something trivial and something serious, or something that requires immediate attention and not.”
I would interpret that as a straightforward confirmation that it was in fact annoying. There would be no resulting awkwardness but it would definitely not make me more likely to speak up again.
“Taking care of you is my sacred duty. I care about you. It is important that you tell me if there is something wrong.”
This is true literally and in spirit.
To invoke a cheesy meme, I wish I could upvote twice, once for phrasing something that doesn’t involve telling a white lie, and the second time for consciously reinforcing that patient care is a sacred duty.
I would count it as a white lie. It’s literally accurate, but it implies a number of things. Some of those things are correct (you consider it important to care for the patient and be informed of any problems), but some of those things are incorrect (you are not annoyed). It isn’t disqualified as a lie just because you believe that your annoyance is not important.
I don’t think that the nurse is implying that he is not annoyed. Both the patient and the nurse recognise that the ‘crapping the bed’ situation is an annoying one, and the nurse is not denying that. The nurse is simply making it clear that his annoyance is a secondary concern, and that instead the welfare of the patient is the primary concern. The nurse genuinely believes that his own annoyance is relatively less important, and he is conveying that literally to the patient. This is actually the true situation, so I am confused about how you think he is lying, even implicitly.
If you go sufficiently upthread, you’ll find that it started with a post by Swimmer963 who is a nurse and is relating her own experience. In particular, she says:
Sorry, I should clarify. I was saying that:
Is precisely something that Swimmer963 could say even though she’s annoyed. She doesn’t have to deny that she’s annoyed, or even imply it. In fact it’s probably futile to try… of course she’s annoyed, and the patient suspects that. That is exactly the motivation for her lie in the first place.
The statement above nevertheless conveys her overall commitment to the patient’s wellbeing, and encourages the patient to understand that “Obviously, my nurse is annoyed about the crap in the bed, but there are more important factors at play here.”
As an extra bonus, I don’t think it’s a lie, hence providing a response to Eliezer’s implied challenge.
On the contrary, her claimed standard response:
Contains three lies, none of which will probably even be believed by the patient:
My point is that Swimmer963′s strategy probably doesn’t really achieve her goals, lying or no lying, and in my original post I was suggesting a possible (honest) alternative.
If a nurse started talking to me about her “sacred duty”, I certainly would not believe her.
What about if she just said: ‘duty’?
That’s not quite sufficient as it’s the word “sacred” which does the heavy lifting. Saying it’s her duty isn’t particularly meaningful for a nurse—it’s her job, that’s what she is paid to do. She is not doing you a favour, cleaning up shit is right there in her job description.
Would you believe them more or less than if they said they’re not annoyed that you shat the bed?
That depends. Mostly on the non-verbal clues that accompany the statement, but also on what do I know about this particular nurse.
Well the classic lie in medicine is when a sibling confides in the doctor that he doesn’t want to donate a kidney to his brother or sister and he’s just getting tested out of family pressure. I understand that in such a situation, the doctor will normally lie and say that they ran the tests and the sibling is not a compatible donor.
Actually, regardless of the reason, they just say that “no suitable donor is available.” If pressed, they say they never release potential donors’ medical information to recipients, for confidentiality and to protect donors from coercion.
That’s interesting . . . what happens if the potential donor asks for (and is willing to sign a release) so that his medical information can be released?
Depends. Different countries have different laws governing such. For the most part, if the hospital sees any legal liability at all, they’ll do the standard CYA. Signing waivers / releases often doesn’t do a whole lot, some of your rights you cannot sign away. Regarding your question, with releasing medical information, such waivers shouldn’t be a problem, although the transplant scenario may be a special case.
Regardless of the legalese, transplant doctors typically get to know you quite well, and more information slips out (implicitly and explicitly) than may be allowed by law (HIPAA be damned). Nullum ius sine actione, as they say. If noone complains, noone sues. Bit like driving without seatbelts.
I’m talking about the United States.
i.e. you don’t know either.
This is an interesting situation, after all, a simple utility calculation says that the receiver’s life is worth more than the donor’s annoyance. Then again, we’re getting close the the cases where utilitarianism fails horribly here.
Well I think most people are reasonably comfortable with the idea that every adult should have complete discretion over what—if anything—is done with his organs.
The more interesting question is what to make of people who lie to conceal decisions in this area, especially physicians.
Yes, but what do you mean by “complete discretion”? After all, the donor was in fact willing to go through with it despite the misgivings, i.e., he valued his relationship with his family more then the annoyance of donating.
And while we’re on the subject of the donor’s preferences, note that both seem to score higher than his sibling’s life. Draw your own disturbing conclusions from that.
By that reasoning if there was some situation where he had to sell himself into slavery to save his sibling’s life, similarly disturbing conclusions could be drawn from his refusal to do that.
You’re making an awful lot of assumptions, including the assumption that the person is a utilitarian and that their reasons for not wanting to donate don’t also involve life or considerations that a wide range of people consider as important as life.
I mean that a potential donor should be able to decline for pretty much any reason, no matter how trivial or silly.
I’m not sure who you are talking about here. In the hypothetical I presented, the potential donor was not willing go through with the donation.
Disturbing or not, it’s reality. A lot of people would not donate a kidney to save a sibling. Either because they hate their sibling and hope that he or she dies sooner rather than later; or because they are selfish and wouldn’t lift a finger to save a family member; or for some other reason.
Anyway, you keep trying to change the subject away from the issue of lying. Please stop it.
Well, in the example he can decline, he will simply have to deal with the consequences.
In which case, what would he do if the tests came back positive?
I’m pointing out flaws in the rationalization for lying.
Agree, but so what?
Positive for what?
What exactly is the flaw in your view? I’m not saying there is none, I’m just trying to understand your position.
So the potential donor still has complete discretion and thus there is no reason for the doctor to lie.
For compatibility as a donor.
Near as I follow your logic, the reason for lying is that the doctor is trying to protect the patient’s right to over what—if anything—is done with his organs. However, as I pointed out that right is not under threat, what is under threat is the patient’s “right” for his decision to have no consequences.
I disagree. For example, the potential donor might want to lie to spare the feelings of his sibling. Or to forestall family members from getting annoyed at him.
Lie and say he was incompatible. That’s kinda the point of this subthread.
Not exactly—the reason for the doctor lying is to prevent hurt feelings and family discord.
Sparing somebody’s feelings is a much worse reason for lying than protecting their right to bodily autonomy.
I meant what would the donor do if the person refused to lie.
I don’t disagree with you . . . have I suggested otherwise?
I don’t know, it would be up to the potential donor. But either way he gets to make his decision and nobody in this discussion is disputing that. Agreed?
ETA: Now that I have explained why medical personnel might lie about compatibility, is there any other flaw in your view? At this point, is there anything I have said which you disagree with?
For a consequentialist, having decisions have “consequences” should not be a terminal value. If decisions having consequences cause those decisions to not be made, that is good, but decisions having bad consequences is, in and of itself, bad.
But it is instrumentally useful if people’s decisions have consequences to the person doing the deciding that are correlated with the net affect of their decision.
Huh? We aren’t discussing the sibling’s decision to give or not give the kidney, we’re discussing the doctor’s decision, given that the sibling isn’t donating the kidney, to tell the patient that the sibling is a match. Are you implying that the doctor should reveal the match, so the patient will pressure the sibling into donating?
That is what the basic utility calculation shows, yes.
Your reference to SAT scores is rather odd. I suppose there is probably some correlation, but they are really quite different skill sets.
How about adding a tiny bit of ambiguity (or evasion of the direct question) and making up for it with more effusiveness, eg, “it’s not only my job but it feels really good to know that I’m helping you so I really want you to bug me about even trivial-seeming things!” All true and all she’s omitting is her immediate annoyance but that is truly secondary, as she points out below about first-order vs second-order desires.