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It is generally agreed that trust is an essential element in the doctor-patient relationship, and it is agreed that there are types of behaviour that doctors should rarely, or never, engage in, since such behaviour undermines this trust. For example, doctors should do their best to explain treatment procedures to their patients and strive to help patients understand their nature and purpose. Doing these things minimises the risk of unpleasant surprises for patients, which can lead to a sense of betrayal. Confidentiality is similarly seen as well-nigh indispensable to the relationship between doctors and their patients, and only to be set aside in a few exceptional circumstances, such as when a patient is likely to pass on the HIV virus to another person, without that person's knowledge. Also crucially important, and increasingly recognised as such within the medical profession, is the duty of openness and honesty. Although not mentioned in the Hippocratic Oath, there has for some while been a growing feeling that doctors have a prima facie duty not to deceive their patients.
The notions of honesty, openness, truthfulness and non-deceptiveness are clearly related, though subtly different. They all invite clarification, and there are many occasions when it is not obvious whether a doctor's behaviour conforms to them. My concern is to examine the real or alleged moral differences between deception by means of lying, and other forms of deception, verbal or non-verbal. Is lying always wrong (or at least prima facie wrong on account of it being lying), but other forms of deception sometimes acceptable? Or-a different point-if all deception is wrong, is lying morally worse than non-lying deception? Both the opinion that lying is different, and the opinion that it is not, have thoughtful defenders. The latter view attracts thinkers with utilitarian tendencies, who say that if the foreseeable consequence of some utterance is the creation of a false belief, it cannot matter whether or not this is achieved by lying. Indeed, they might think it can be even more dishonest to try to create false beliefs by means of non-lying deception, as this strategy may involve an attempt to conceal from oneself what one's real intentions are. Others, however, adopt the former view. According to them, although it is by no...