I know I blogged about it last week, and I don't intend for this to become the Downton Abbey forum (fun as that would be), but the hit Masterpiece series has again raised an issue that's as relevant to medical practice today as it was in 1920 when the drama is set. Since the last episode, people have been asking me whether I thought Dr. Clarkson told a lie, which got me thinking about whether it's ever okay for a doctor to lie to patient.
SPOILER ALERT: If you have not watched the fourth and fifth episode of the third season, read no further.
To recap: Lord and Lady Grantham's marriage is on the rocks after the postpartum death of their youngest daughter, Sybil. Lady Grantham blames her husband, who trusted the arrogant, society obstetrician, Sir Phillip Tapsell. Sir Phillip had ignored warning signs of the deadly condition, eclampsia, to which Sybil succumbed. The family doctor, Richard Clarkson, had recommended bringing Sybil to a local hospital for a risky cesarean, her only hope of survival, but Lord Grantham ignored his advice.
In an attempt to reconcile the couple, Lord Grantham's mother, the Dowager Countess, summons them to her home along with Dr. Clarkson. She'd met with the doctor previously, and asked him if he might revise his assessment of Sybil's chances of being saved by a cesarean. Clarkson now tells Lord and Lady Grantham that he's done some research and realized that he may have misrepresented Sybil's situation earlier. He now says that she actually had only an "infinitesimal" chance of surviving, even with the cesarean. Sybil's parents fall into one another's arms, grieving but no longer at odds about the circumstances surrounding their daughter's death.
So did Dr. Clarkson lie? I think yes...and no. I don't believe for a minute that he did any further "research." He simply re-spun what he knew all along in the most compassionate way. When Sybil was still alive, it was most compassionate to emphasize her chance of survival, however small. Once she was dead, it was most compassionate to emphasize her death's inevitability.
I don't consider this kind of selective emphasis lying--and doctors still do it all the time.
Back in the paternalistic bad old days of medicine, doctors decided what a patient should and shouldn't know. Until the 1970s, even a cancer diagnosis might be withheld from a patient if the doctor thought it would be too upsetting (think of poor Ali MacGraw in Love Story).
But presenting a possibility with a particular slant (that's what Clarkson did) isn't lying, because possibilities aren't facts--even when they're based on statistics and "research." If a middle aged man has chest pain, I'll tell him to go to the ER because he might possibly be having a heart attack. If he decides to stay home and dies, it would be cruel of me to to tell his widow that he possibly would have survived if he'd listened to me.
I think Dr. Clarkson did the right thing, and I would have done the same.
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