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brazil84 comments on White Lies - Less Wrong
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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.
I disagree. For example, the potential donor might want to lie to spare the feelings of his sibling. Or to forestall family members from getting annoyed at him.
Lie and say he was incompatible. That's kinda the point of this subthread.
Not exactly -- the reason for the doctor lying is to prevent hurt feelings and family discord.
Sparing somebody's feelings is a much worse reason for lying than protecting their right to bodily autonomy.
I meant what would the donor do if the person refused to lie.
For a consequentialist, having decisions have "consequences" should not be a terminal value. If decisions having consequences cause those decisions to not be made, that is good, but decisions having bad consequences is, in and of itself, bad.
But it is instrumentally useful if people's decisions have consequences to the person doing the deciding that are correlated with the net affect of their decision.
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.