Deception and the Clinical Ethicist

In this article, I defend a discomfiting thesis: The clinical ethicist should sometimes be an active participant in the deception of patients and families. The case for this conclusion builds off Sissela Bok's seminal analysis of lying, from which I emphasize that, despite some common intuitions to the contrary, there is prima facie no morally relevant difference between lies of omission and commission. I then discuss deception's prevalence in medical encounters, noting that the ethicist is often embedded in corresponding decisions, and explicate the realities that underlie these tough cases. Among those realities is the fallacy that deception can always be avoided through better communication. I conclude with an elaboration of ethicists' role-model status and argue that they can turn the deception into a powerful teaching moment about the complexity of ethics reasoning.