Time Past

by Theodore Dalrymple (February 2013)

When, as sometimes happens as I get older, I lie awake at night unable to sleep, my mind returns to episodes from my past. As to the future, I can seldom think further ahead than the next article I am to write. I can dwell for any length in my sleeplessness only on the past.

This calmed the bride, who concluded what she wished to conclude, that she must have been mistaken. And immediately afterwards I felt a great pride: pride that the groom, clearly an educated and intelligent man, had felt sufficient confidence in my intelligence and savoir-faire to ask me (at my age!) his question and that I would appreciate its real significance. How mature and sophisticated I felt, how proud that I had passed the test and come up to his expectations!

It also taught me the inescapable necessity for paternalism in human relations: not, of course, on every occasion, or invariable, but sometimes, on occasion, as suggested by judgment. As a doctor I have never forgotten this, though paternalism has become almost a dirty word in medical ethics. There must, of course, be a presumption in favour of truth-telling, but like almost any other principle it much not be made into a categorical imperative or, to put it more crudely, a fetish.

I was in Africa when I telephoned my mother (by no means the easy thing to do then that it is nowadays). She was about to go to America on a visit, but she told me that she had been bleeding intestinally. I told her she must abandon her visit and see a surgeon at once, which she did.

I assume that the surgeon, who is a hero to me, acted differently according to his assessment of the clinical situation confronting him: that breaking medical confidence and untruthfulness by omission were not fixed principles with him that he applied in every case. But this is surely very unlikely.

Instead, his understanding of the requirements for human decency was much more sophisticated than that of modern medical ethics. He understood that people generally live in a social situation, not as isolated beings, and that it is sometimes right for relatives to know more about an illness than the ill person him or herself. And I am sure that he knew that truthfulness can descend into indifference to suffering or even to sadism. To try to force people to know what they do not want to know can be cruel, and often ineffective into the bargain.

But when I recall the couple in Scotland, I still feel a certain pride at my moral intuition.

Farewell Fear.

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