Here’s a poser: imagine that your patient comes to you reporting the canonical symptoms of a condition that is untreatable. You agree that this patient is suffering from something, and that the reported symptoms tally with those that are reported by other sufferers. However, the reason that the disease is untreatable is that – frankly – there’s no such thing.
Or, rather, there is a medical condition associated with these reported symptoms, but there’s no evidence for it being anything other than psychosomatic. Frankly, anyone suffering from this “disease” is delusional. And yet “sufferers” are well-organised, and by no means stupid; they are convinced not only that they’re ill, but that at least parts of the medical establishment are being (at best) pig-headed in ignoring their plight. Welcome to the world of Morgellons. (According to some, it’s very close to the world of Chronic Fatigue Syndrome. Both conditions are medically controversial, both lead to undeniable suffering, both boast active lay activists, and so on.)
Being told that they are not deserving of medical attention risks alienating sufferers and will not make them abandon their false beliefs; and, besides, it would miss the point. Noone denies that putative Morgellons patients are suffering from something debilitating: it’s the identity of that something that’s open to doubt. Besides: there is something medicine can do. It can provide placebos, for example. Or it can provide anti-psychotics. Of course, a patient who’s convinced that there is something organically amiss won’t take kindly to being given anti-psychotics – so you’d have to lie and say that they were something else. Result: patient gets better, but the disease “diagnosis” gains some gravitas: if people can suffer from it, and it can be treated, then it looks like a proper illness.
So there’s a pragmatic worry, with an ethical dimension, that we may associate with this course of action. But there’s also a couple of more direct ethical worries. In the first place, in prescribing antipsychotics, you’d be prescribing a powerful drug that would be unnecessary. Well – hang on: would it be unnecessary? if it shifts a debilitating condition, and is the most immediately effective way of doing so, what’s the criterion of necessity here? (Granted, psychotherapy of some sort might get the same results, but that’d depend on the patient accepting that psychotherapy was in order, and turning up to the appointment.) But it would be prescribed under false pretences – as would a placebo – and this raises questions about truth-telling. (Martin Robbins has more on this.)
It seems that we might be getting into noble lie territory here: the idea that doctors may distort the truth in order to achieve results that all would agree are desirable. Note that “noble lie” is a translation of gennaion pseudos, and the verb pseudesthai means originally not to lie, but to twist. Twisting is what would be going on here: medics would be treating a real problem – just not quite the one that the patients think they have, and not in the way that they think it’s being treated. Still, implicit in going for medical help is the expectation that you’ll be made better, and if a little twisting is necessary for that, then what’s the problem? Anyone – doctor or patient – who wills the end of health presumably infallibly wills also the means necessary thereto.
The point is this: it’s very easy to get carried away by the need for truthfulness – but claims made about the importance of truthfulness may potentially come a cropper when people have a strong belief in an illness’ existence and effects on them. The notion of valid consent, which requires truth, seems to demand that the patients have something like a truth-tracking lebenswelt. If that’s not the case, then many bets seem to be off. In such cases, when claims about the nature of an illness are (as far as anyone can tell) systematically erroneous, then there may be a case for ditching truth in favour of something more like truthiness – the quality by which one’s statements have the emotionally satisfying ring of plausibility without actually having all that much to do with reality. The occasional noble lie might have a place in decent medical practice.
Oh – incidentally: if you’re an ME or Morgellons sufferer and you want to post an angry response, please note that I’m going to be away for a week, so I won’t be able to get back to you too quickly. And if you’re going to complain about my Greek – well, you wouldn’t be the first. It’s terrible.