Lying for the Patientʼs Good

D.B. presents to the orthopaedic surgeon's office with a knee injury. He informs the surgeon that he injured the knee at work. The physical examination is consistent with a torn medial meniscus. The surgeon requests a magnetic resonance imaging study and tells the patient that, depending on the results of the scan, arthroscopic surgery may be necessary. D.B. then explains that he no longer has health insurance, but, by saying that the injury occurred at work, his treatment will be covered by Workers' Compensation insurance. On further questioning, it seems unlikely that the injury did occur on the job. D.B. asks the surgeon to report the injury as work-related; otherwise, he will have to pay for the surgery himself and he cannot afford the expense. All of us are well aware of our ethical commitment to act for the good of our patients. But how far does the scope of that dictum extend? The case above raises the question of whether doctors should be concerned only with patients' health and medical well-being or whether they should also take an interest in other things that are of importance and value to their patients. Although in most circumstances it may seem very clear that doctors are not obligated to improve the financial situation of their patients, in some circumstances the extent of the physician's responsibility is not so obvious. The health-insurance structure in the United States leaves approximately 40,000,000 patients and their doctors facing difficult dilemmas about what they will sacrifice to be able to obtain or provide needed medical treatment. In the case above, the doctor and the patient confront the question of whether truth, health, or money should be relinquished. In this particular case, and in other similar situations that we …