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Swimmer963 comments on White Lies - Less Wrong
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There are certain lies that I tell over and over again, where I'm 99% sure lying is the morally correct answer. Stereotypical example: my patient is lying in a lake of poop, or is ringing the call bell for the third time in 15 minutes to tell me that they're thirsty or in pain or need a kleenex, and they're embarrassed and upset because they're sure I must be frustrated and mad that they're making me do so much work. "Of course I don't mind," I've said over and over again. "This doesn't bother me. I've got plenty of time. I just want you to be comfortable, that's my job." When it's 4 am and I desperately want to go on break and eat something, none of these things are true. But it's my job, and I want to want to do it, so the fact that sometimes I desperately don't want to do it is kind of moot. But the last thing a patient in the ICU needs to hear from their nurse is "yes, I'm pissed that you shat in the bed again because I was about to go on break and now I can't and I'm hungry and cranky." I keep that to myself.
...Other than that, I generally don't lie to friends, although I do lie by omission, especially when it comes to my irrational feelings of frustration or irritation with things they do. I'm generally not bothered by being very open with people about i.e. my relationships or other personal things, so I'm confused when other people want to lie or conceal information about these sorts of things. I actually have a really hard time keeping up with other people's systems of lying; when you're friends with two people who both have specific lists of things they don't want you to ever tell the other person, it gets complicated. (For almost a year my best friend was dating a man without telling her ex-husband, and I was seeing her ex-husband every time I went to play with my godson, and I had to remember to lie about a whole bunch of random things like "what did you and my ex-wife do on Saturday?" I respected that it was her choice whether or not to tell him, but I still found this really, really irritating.)
When a student asks me to write her a letter of recommendation and expresses some concern that this will be a bother for me I have said "Don't worry, that's part of my job" to signal that the request is appropriate.
I'm not sure there's a lie happening... it seems to me that in said circumstances the meanings of the sentences are conventionally mapped, like:
"yes, I'm pissed that you shat in the bed again because I was about to go on break and now I can't and I'm hungry and cranky." -> I'm incredibly angry with you and I'm going to find out a way to kill you so you don't bother me again. (Exaggerating a bit here for effect)
"Of course I don't mind" -> of course I do mind but it is not as bad as the example above.
Sentences mean what the listener makes of them, that's why you have to speak a foreign language when talking to a foreigner who doesn't speak your language.
A similar argument occurred to me, but I think it does border on proving too much. It also depends on knowing what the listener will make of the sentence. I think that the concept of "lying" does depend largely on the idea that the explicit, plain meaning of a sentence having a privileged position, over implications, signalling, Bayesian updates caused by the statement, etc. If someone says "Well, the probability of me telling you that I am not having an affair, given that I am having an affair, is not much smaller than the probability given that I am not having an affair, so if you significantly updated your prior simply because of my denial, the blame is on your end, not mine", I don't think many people would find that a reasonable response.
I think I pinned down the distinction here.
If you tell something like this: "yes, I'm pissed that you shat in the bed again because I was about to go on break and now I can't and I'm hungry and cranky.", the patient is going to form a lot of important beliefs regarding the question they're asked that are not true, more than if you say "this doesn't bother me". You have to say what ever sentence ends up misleading the patient the least about what they want to know.
For the affair on the other hand, it is not so, they'd form more valid beliefs if you said that you are having an affair, than if you say you don't.
The truth is such word noises, body language, intonation, and so on, that mislead the listener the least. Usually has to be approximate due to imperfect knowledge and so on.
Having an affair is discrete, while the annoyance level is continuous. There's simply no explicit, plain meaning possible for continuous variable like that, one has to deduce it from the tone of the voice, body language, etc etc etc etc. One could of course have friendly body language and tone while saying something like "yes, it is incredibly annoying" but that would merely confuse the listener.
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.
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.
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.
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.
"Don't worry about it."
Imperatives are often a nice fallback.
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.
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.
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."
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!".
"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'?
Would you believe them more or less than if they said they're not annoyed that you shat the bed?
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.
I'm curious about how you, being a nurse, would prefer that the patient behave in situations like this? There don't seem to be great options - is there a least-bad attitude?
...I feel like a lot of that boils down to stuff out of patients' control, like "don't be confused or delirious." Assuming that my patient is totally with it and can reasonably be expected to try to behave politely, I prefer that patients tell me right away when they need something, listen to my explanation of what I'm going to do about it and when I'll be able to do it, or why I can't do anything about it, and then accept that and not keep bringing up the same complaint repeatedly unless it gets worse. I have had patients who rang the call bell every 5 minutes for hours to tell me that they were thirsty, when I'd already explained that I couldn't give them anything by mouth, or that their biggest concern was being thirsty but I was more concerned that their heart rate was 180 and I really really needed to deal with that first.
I obviously prefer it when patient's aren't embarrassed and I can joke around with them and chat about their grandkids while cleaning their poop. But emotional reactions aren't under most people's control either, so it's not a reasonable thing to ask.
My ex wife is in Geriatrics and I've heard a few situations from her where she, possibly appropriately, lied to patients with severe dementia by playing along with their fantasies. The most typical example would be a patient believing their dead spouse is coming that day for a visit, and asking about it every 15 minutes. I think she would usually tell the truth the first few times, but felt it was cruel to be telling someone constantly that their spouse is dead, and getting the same negative emotional reaction every time, so at that point she would start saying something like, "I heard they were stuck in traffic and can't make it today."
The above feels to me like a grey area, but more rarely a resident would be totally engrossed in a fantasy, like thinking they were in a broadway play or something. In these cases, where the person will never understand/accept the truth anyway, I think playing along to keep them happy isn't a bad option.
Relevant recent Slate Star Codex post
Just saying "this is part of my job and I love my job" is not good enough?
I wonder if there is a better way of handling this, other than telling your best friend that you are not going to be a part of this game and risking a backlash... In a similar situation I ended up curtailing my interactions with the party I'd have to lie habitually to, which is rather suboptimal.
It sounds evasive and not like the natural response, and I'm not all that worried about my patients yelling "no, you're a liar!" and getting mad if I tell them I don't mind at all, and I don't have any particular reason to want to not lie in this situation.
What's good enough for alleviating discomfort so cheaply as with a few words if there's still better left? Showing you care about the people instead of some abstraction called a job usually works better for making them comfortable.