Are fake diagnoses and false or misleading certificates permissible means of helping patients? This question is examined in relation to four examples from Swedish health care: the sterilisation case, the asylum case, the virginity case, and the adoption case.
We argue that both consequentialist and deontological ethical theories, to be reasonable, need to balance values, principles, and interests such as wellbeing, truthfulness, autonomy, personal integrity, trust in the medical profession, and abidance by national legislation.
We conclude that it can be justifiable for physicians to fake diagnoses and write false or misleading certificates in order to help patients when not doing so has dire consequences. However, physicians must also consider the long-term effects of making exceptions to honest, non-deceitful behaviour based on the best empirical evidence available. Otherwise valuable social practices might erode and public confidence in physicians be threatened.
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Competing interests: None.
↵i According to Korsgaard, Kant would not accept this conclusion, but she argues that this would be a mistake on his part. In Korsgaard’s view, Kant’s moral theory is restricted to concern only what ideally should be the case; that is, what our duties would be in an ideal world. But we need a theory that can tell us what to do also in less than ideal circumstances. What should we do in unfortunate circumstances and when not everyone acts in accordance with the dictates of morality? Korsgaard suggests that the solution is a two-level theory, where one level deals with the ideal and points out what to strive for when the ideal cannot be achieved, and another level deals with what to do in our less than ideal realm. While Kant does not seem open for this suggestion in his writings on moral theory, Korsgaard points out that he does seem to reason in a similar way when he writes about the duties of nations in times of trouble. See reference 21.
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