Tuesday, November 8, 2011


On the radio this morning, a doctor was talking about a patient of his, named Martha.  At regular intervals, Martha suffers from amnesia, and needs to be reminded of crucial elements of her life.  One key piece of information she forgets, is that her husband died a while ago.  At regular intervals, then, Martha will ask where her husband is.  The doctor's dilemma is what to say in reply.  If the doctor tells the whole truth: 'Your husband has died', then Martha becomes extremely upset, and suffers a grieving process.  Then, later, if she forgets again, and asks once more, then if the doctor repeats the information, Martha yet again will suffer extreme grief.  The question is this: is it better to tell the whole truth every time, causing extreme grief every time; or is it better to withhold the truth in the interests of avoiding suffering?  Martha has two daughters.  One accepts the withholding of information to avoid suffering.  But the other daughter believes quite strongly that to withhold an important truth is abusive, and the truth should be told, however much suffering it causes.  Which daughter is right?

We will all have a natural response to the dilemma.  For my own part, I have a strong instinctive preference for telling the truth at all costs.  If someone asks me something, I will feel constrained to reply as clearly as possible, because I have a strong belief that the truth is an important possession, and we steal it from others if we withhold it.  However, I am aware that different people have different instinctive responses to the same dilemma.  I remember my parents making decisions to withhold information from their children in order to avoid suffering: they clearly believed that children should be protected from certain truths, so that they could grow up happy and content.

One of the important principles for the doctor mentioned above, was the principle of acting in the best interests of the patient.  Under this principle, it would be clearly wrong for a doctor to withhold information simply because it made the doctor's life easier - that would not be prioritising the patient.  But even if we accept the principle 'always consider the best interests of the other person', it does not resolve a major dilemma, which is this: is it in someone's best interests to know the truth, even if it makes them suffer?  Or is it better for them to remain unknowing, if that keeps them happier?

In practice, one way we resolve this dilemma is by using another overriding principle: that of consent.  We are able to ask the other person: would you rather know, or not know?  For instance, the doctor could ask Martha in the example above: 'Martha, when you forget, do you want us to remind you, when you ask, that your husband is dead?'  If Martha says yes, then the decision is made.  If she says no, then equally, the decision is made.

However, there is one more important factor which we can control, even if we choose to tell the truth.  We can decide where to direct the attention of the person.  In the example of Martha above, it may be that she can be distracted onto other subjects: perhaps she has children or family to think about, which will draw her attention away from the sad fact of her husband's death.  As a parent, although I always tried to tell my children the truth about everything, I was still able to manage the focus of our attention, so that we didn't become too obsessed by one thing.  In this way, even if we decide to share the truth with people frequently, we can still take responsibility for helping to manage awareness, so that sad truths are counterbalanced by happier things.

Think for a moment about what you tell yourself.  In a way, every moment of the day, we are in the position of Martha.  Our mind is always asking us: 'What is happening? Where is everybody?'  And we are also in the position of the doctor!  How shall we reply to ourselves?  Shall we keep on reminding ourselves of sad things, or focus on happy things?  The issues of consent and attention apply to our self-management.  Ask yourself: 'When I am ready to think about life, where do I want my attention to focus?  Do I want to hear the truth?  And even if I make myself aware of the truth, and accept it, what shall I do then?  Shall I draw my attention to happy things, or sad things?'

The above example of Martha is extreme.  But it reminds us strongly that we all have a responsibility to make good choices about sharing the truth, and focusing attention, with those we care for, and even with ourselves.  The decisions aren't easy, but perhaps the important thing is to  keep in mind the best interests of the person we are dealing with.