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knb comments on Not Technically Lying - Less Wrong
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I guess this is where I come down on this:
Whether you say 2 or 3, you are deliberately encouraging false beliefs in your patient.
Assuming that your patient is not an abnormal human decision maker, he would probably prefer less pain over some trivial but accurate information about what substance is in a bag.
If you are a utility-maximizer or a volition-extrapolator you would tell the guy whatever lie seems most likely to mitigate his suffering.
Very good, what the patient wants is more important than my conscience.
You should try to get a better conscience... one that wants what the patient wants.