by J.S. Blumenthal-Barby, Ph.D.
Atul Gawande: “I came on board after she got diagnosed with that second cancer. And in my mind I was thinking ‘I wouldn’t offer this surgery because the lung cancer is going to take her life.’ And yet I didn’t feel I could say that to you. I think we started talking about the experimental therapy that you all were hoping to get on with the trial for the lung caner. And remember saying something I sort of regret, which was that ‘maybe that sort of experimental therapy will work for the thyroid cancer too.’ [laughs and shakes head] I said that. And I know it was a complete…I knew it was not going to…in other words, the reason I regret it is because I knew it was a complete lie. I just was wanting something positive to say.”
Patient’s husband: “I did not know it was an outright lie. You could lose your license for that you know?” [chuckling]
This exchange took place during last week’s Frontline episode on “Being Mortal” with Atul Gawande. It involves a powerful confession of what I would imagine is a fairly common phenomenon. Atul Gawande characterizes what he did as “lying,” but is there another way to think of it and what are we to make of it morally?
The philosopher Harry Frankfurt has written about the distinction between “lying” and “bullshitting” in his essay On Bullshit. Frankfurt notes that lying involves saying something that one knows to be false (e.g., telling someone that something feels good when you know in fact that it feels bad). Liars are concerned with the truth-value of what they say; they just intend to say something with a truth-value of zero—namely, something that is false. The liar aims to hide a fact about himself as well, namely, the fact that he wants to lead us away from a correct apprehension of reality.
The bullshitter is more nuanced and subtle. Frankfurt writes, “The fact about himself that the bullshitter hides, on the other hand, is that the truth-values of his statements are of no central interest to him; what we are not to understand is that his intention is neither to report the truth nor conceal it.” He further writes, “It is just this lack of connection to a concern with truth—this indifference to how things really are—that is the essence of bullshit.” Frankfurt calls to our imagination a traditional “bullshitting” session where people are “trying out” various thoughts, attitudes, and expressions to see how other people respond, noting that generally everyone part of one of these sessions understands what is going on and that was is being expressed is not necessarily truth.
How ought we to characterize the sort of thing that went on with the Atul Gawande example? To me, it seems a bit of both. On the one hand, Gawande does confess that he told the patient and her husband something that he knew to be false—and he apparently did a good job of hiding the fact that he was leading the couple away from a correct apprehension of reality given the husband’s surprise about “the outright lie.” But there seems to be something further and subtler going on as well that is closer to bullshitting. Namely, that the driving force may not have been an interest in communicating and ascertaining truth but in making everyone feel better—as Gawande put it, “with having something positive to say.” And, arguably, in most cases like this (though not this one, as the husband seems genuinely surprised), the people involved in the case may all know “deep down inside” that what is going on is a skirting around the truth.
The moral status of lying and bullshitting in medicine would require a much fuller treatment than I have space or time to do in this blog post—the transgressions of the boundaries of truth are not always necessarily bad. But Frankfurt says something very interesting about the moral perils of bullshitting that is well-worth considering:
“Lies [do] not tend to unfit a person for telling the truth in the same way that bullshitting tends to. Through excessive indulgence in the latter activity, which involves making assertions without paying attention to anything except what it suits one to say, a person’s normal habit of attending to the way things are may become attenuated or lost.” (p. 60).
In this way, bullshitting, which may seem more innocuous, commonplace, or well-intentioned, is even more morally dangerous than lying.