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Is the right not to know an instance of ‘bad faith’?
  1. Aisha Deslandes
  1. Houston, Texas, USA
  1. Correspondence to Aisha Deslandes, Houston, TX, USA; aishadeslandes{at}gmail.com

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The ‘right not to know’ (RNTK) can be used by patients as a safeguard against the effects that certain medical information can have on their well-being. At first glance, one might reason it suitable for a patient to enact their RNTK. However, although Davies states that RNTK gives people the ability to both protect themselves from self-perceived harm and exercise their autonomy, I will argue that ‘not knowing’ hinders patients’ ability to exercise their existential freedom and represents what Sartre calls an instance of ‘bad faith’.

Davies argues that the RNTK takes precedence over many related issues and objections associated with a patient’s decision to implement such a resolution.1 Fundamentally, the RNTK gives patients power to protect themselves from subjective harm and to exercise their autonomy. In most cases, objectors of RNTK cite the negative impact on the patient’s state of health, which affects not only the patient but also those persons who would also be negatively affected by patient health outcomes. For the majority of objectors, patients have moral obligations to lessen the degree of burden on others, which refusal can initiate. However, Davies concludes, ‘…the burden placed on others is not sufficiently significant to warrant the risk of placing pressure on someone who has a legitimate reason for avoiding medical information…Patients may have an obligation to know, and yet a right, held against medical professionals, not to be told information they do not want to receive’ .1

This argument may raise questions of how to further mitigate difficulties that occur when the RNTK conflicts with values held by medical professionals. The focus in this commentary, however, is to point out that while the RNTK appears to empower patients’ sense of autonomy, patients in a way become disempowered by refusing knowledge of their medical information because in doing so, they deceive themselves and forfeit their true freedom. In his work, Being and Nothingness, existentialist philosopher Jean-Paul Sartre calls this type of self-deception bad faith.2

For Sartre, the ‘facticities’ of life impose on us certain ‘givens’ or present truths that are permanent and beyond our control. These factual truths, such as our parents, age, gender, where we were born, physical characteristics, the language we speak or even the onset of illness, the loss of a loved one and our eventual death, are imposed on our being in the world. Nonetheless, we are also free to transcend (willfully go beyond) these truths by how we interpret them. This dichotomy between the facticity of one's life and the capacity to freely construct our own meaning to our reality produces existential tension. Some alleviate this tension by denying conscious truths and acting on their denial as actual truths. In other words, they lie to themselves. This is called bad faith.

Patients can exercise their freedom (or not) with respect to the facticities and givens of their own lives. Patients decide how to act to givens related to their health, such as whether to seek or refuse treatment. A particular issue with RNTK, however, occurs because the patient desires to refuse all ‘given’ medical knowledge. By refusing to know, patients also refuse their truths.

However, according to Sartre, we are ‘necessarily free’ and condemned to a life of having to make free choices. Denying relevant information means choosing not to respond (accept, decide, contemplate and act) to our present facticity. Moreover, rejection of this kind is inauthentic to our subjective freedom. For example, a wooden chair lacks the mental capacity to think or to decide to do anything; thus, if we ask a chair to do something, it does not respond because it is an object with no subjective existence. Given that we are able to mentally reflect on ourselves, if we are given the right to information regarding our lives and refuse to know it, we essentially act as lifeless objects instead of necessarily free beings.

Sartre demonstrates an example of bad faith, which observes a woman's subjective reaction to a man who is interested in her romantically. While on their first date, sometime during the evening, the man tells the woman how physically attractive she is. The woman, feeling uncomfortable by the man’s declaration, has not yet decided how she feels about him. However, she is fully aware of his apparent romantic interest in her, which was made evident in his sexually suggestive tone. Uncomfortable by this tension, the woman resolves to transcend the moment and insists the man’s comment was solely a compliment to her beauty, nothing more. She chooses to deny the truth and transcends the facticity of his exact comment with a more comfortable intrapersonal narrative, making the man’s advances to be a testament of her beauty when, in fact, they were sexual in nature—she wanted the facticity of his sexual flirtation to be something else.

Acting inauthentically, she transcended the gesture into what she wanted and what made her more comfortable and less affected by denying the reality of the true meaning of his remark. Furthermore, such self-deception can become extravagant, as Sartre notes how she lavished in the thought of what she desired the meaning of the gesture to be, enjoying it more than the actual gesture itself.

In the same way, the RNTK can lead patients to believe that, by refusing the reality of their health-related givens, they have freed themselves from the discomfort and accountability of their existential tension. When patients make decisions regarding their health treatment, they are doing so from a subjective and particular view of the world. From Sartre’s view, however, patients have an existential duty to be honest with themselves, which the RNTK challenges.

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Footnotes

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  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Commissioned; internally peer reviewed.

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