6 and amputations. But,' say they, such actions, done for these ends, are not evil. The maxim only determines that we must not do, for a good end, such actions as are evil even when done for a good end.' But this proposition is identic and useless; for who will tell us next, what these actions, sometimes evil, are, which may be done for a good end? and what actions are so evil that they must not be done even for a good end? The maxim will not answer this question; and truly it amounts only to this trifle; you ought not for any good end to do what is evil, or what you ought not to do, even for a good end." Dr. Johnson, who admits of some exception to the law of truth, strenuously denies the right of telling a lie to a sick man for fear of alarming him. "You have no business with consequences," says he; "you are to tell the truth. Besides, you are not sure what effect your telling him that he is in danger may have. It may bring his distemper to a crisis, and that may cure him. Of all lying I have the greatest abhorrence of this, because I believe it has been frequently practised on myself"." If the Medical reader wishes to investigate this nice and important subject of casuistry, he may consult Grotius De Jure Belli ac Pacis, Puffendorff, Grove's Ethics, Balguy's Law of Truth, Fénelon's Telemachus, Butler, Hutcheson, Paley, and Gisborne. Every practitioner must find himself occasionally in circumstances of very delicate embarrassment, with + System of Moral Philosophy, bk. ii. ch. 17. § 7. vol. ii. p. 132. u See Boswell's Life of Johnson, June 13. 1784. respect to the contending obligations of veracity and professional duty; and when such trials occur, it will behove him to act on fixed principles of rectitude, derived from previous information and serious reflection. Perhaps the following brief considerations, by which I have conscientiously endeavoured to govern my own conduct, may afford some aid to his decision. Moral truth, in a professional view, has two references; one to the party to whom it is delivered, and another to the individual by whom it is uttered. In the first, it is a relative duty, constituting a branch of justice; and may be properly regulated by the Divine rule of equity prescribed by our SAVIOUR, to do unto others, as we would (all circumstances duly weighed,) they should do unto us. In the second, it is a personal duty, regarding solely the sincerity, the purity, and the probity of the Physician himself. To a patient, therefore, (perhaps the father of a numerous family, or one whose life is of the highest importance to the community,) who makes enquiries, which, if faithfully answered, might prove fatal to him, it would be a gross and unfeeling wrong to reveal the truth. His right to it is suspended, and even annihilated; because, its beneficial nature being reversed, it would be deeply injurious to himself, to his family, and to the public: and he has the strongest claim, from the trust reposed in his Physician, as well as from the common principles of humanity, to be guarded against whatever would be detrimental to him. In such a situation, [St. Matth. vii. 12.] therefore, the only point at issue is, whether the practitioner shall sacrifice that delicate sense of veracity, which is so ornamental to, and indeed forms a characteristic excellence of, the virtuous man, to this claim of Professional justice and social duty. Under such a painful conflict of obligations a wise and good man must be governed by those which are the most imperious; and will therefore generously relinquish every consideration referable only to himself. Let him be careful, however, not to do this, but in cases of real emergency, which happily seldom occur; and to guard his mind sedulously against the injury it may sustain by such violations of the native love of truth. I shall conclude this long note with the two following very interesting biographical facts. The husband of the celebrated Arria, Caecina Paetus, was very dangerously ill. Her son was also sick at the same time, and died. He was a youth of uncommon accomplishments, and fondly beloved by his parents. Arria prepared and conducted his funeral in such a manner, that her husband remained entirely ignorant of the mournful event which occasioned that solemnity. Paetus often enquired with anxiety about his son; to whom she cheerfully replied, that he had slept well, and was better. But if her tears, too long restrained, were bursting forth, she instantly retired, to give vent to her grief; and when again composed, returned to Paetus with dry eyes and placid countenance, quitting, as it were, all the tender feelings of the mother at the threshold of her husband's chamber. Pliny, Epist. iii. 16. Lady Russell's only son, Wriothesley, Duke of Bedford, died of the small-pox in May 1711, in the 31st year of his age2......To this affliction succeeded, in Nov. 1711, the loss of her daughter, the Duchess of Rutland, who died in child-bed. Lady Russell, after seeing her in the coffin, went to her other daughter, married to the Duke of Devonshire, from whom it was necessary to conceal her grief, she being at that time in child-bed likewise; therefore she assumed a cheerful air, and with astonishing resolution, [verbally] agreeable to truth, answered her anxious daughter's enquiries with these words: 'I have seen your sister out of bed to-day."" NOTE IV. Chap. ii. § 5. p. 50. "The practice of a prior Physician should be treated with candour, and justified, so far as truth and probity will permit." 66 MONTAIGNE in one of his "Essays" treats with great humour of Physic and Physicians; and makes it a charge against them, that they perpetually direct variations in each other's prescriptions. "Who ever saw," says he, one Physician approve of another's prescription, without taking something away, or adding something to it? By which they sufficiently betray their art, and make it manifest to us that they therein more consider their own reputation, and consequently their profit, than their patients' interest"." Lady Rachel Russell's Letters; Note to Letter 149. a Essays, bk. ii. ch. 37. p. 703. [654. ed. 1711.] NOTE V. Chap. ii. § 9. p. 53. Theoretical discussions should be generally avoided. THIS rule is not only applicable to consultations, but to any reasonings on the nature of the case and of the remedies prescribed, either with the patient himself or his friends. It is said by my lamented friend Mr. Seward in his entertaining "Anecdotes,” that the late Lord Mansfield gave this advice to a military gentleman, who was appointed Governor of one of our islands in the West Indies, and who expressed his apprehensions of not being able to discharge his duty as chancellor of his province: "Always decide, and never give reasons for your decision. You will in general decide well; yet give very bad reasons for your judgement." NOTE VI. Chap. ii. § 11. p. 54. Regular academical education. "IT is the general opinion," says Dr. Johnson, "that Sydenham was made a physician by accident and necessity; and Sir Richard Blackmore reports in plain terms, that he engaged in practice without any preparatory study, or previous knowledge, of the Medicinal sciences; and affirms, that, when he was consulted by him what books he should read to qualify him for the said profession, he recommended Don Quixote. That he recommended Don Quixote to b Anecdotes of some Distinguished Persons, vol. ii. p. 386. d In the Preface to his Treatise upon the Small-Pox. |