Honesty Is Best


Is it ethical to lie to patients when you are doing it in their best interests?

I suspect most of us would answer ‘no.’ Lying to patients deprives them of moral agency, impairs their ability to give informed consent and is shockingly paternalistic. The liar imagines that he or she knows better than the patient herself. The liar may even be correct in this assumption, but lying to patients is unethical nonetheless.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Lactivist dishonesty is deadly not just because lactation professionals lie to patients, but because they lie to each other.[/pullquote]

Curiously, both natural childbirth advocates and lactivists, who would be rightly appalled if a doctor lied to them about the risks of childbirth interventions or the benefits of breastfeeding, have no problem lying to women to promote their own ends. Indeed, efforts to promote both natural childbirth and breastfeeding rest on the assumption that telling women the truth will scare women away from doing what is best for them.

Of course activists don’t call it lying. They drape their falsehoods in finery, calling their efforts ‘The Positive Birth Movement’ and ‘Trust Birth’ or the ‘Baby Friendly Hospital Initiative’ and ‘Breast Is Best.’ These sound lovely, but they are lies and paternalism nonetheless.

Consider Milli Hill’s justification for lying to women about the excruciating pain of childbirth.

Most pregnant women are very scared of labour. But by putting all the focus on how painful it is, are we failing to give them the full picture? And in doing so, could we actually be making labour worse – in some sense, setting them up to fail?

Fail? If the baby that’s inside her uterus ends up in her arms alive and healthy, she’s succeeded. When Milli Hill talks about failing at labor she means failing at the conceit of a specific performance of labor — vaginal birth without pain relief or other interventions.

The full picture? What does that even mean in the context of pain? When we tell women that cosmetic surgery involves pain are we depriving them of the ‘full picture’ of face lifts? Or are we giving them what we are ethically required to give them: the truth without which they cannot give informed consent.

The lying and paternalism in lactivism are even worse. Under the guise of promoting what is best for babies, lactation consultants and their organizations aren’t merely lying to women, they are letting babies die. Their motto appears to be ‘Better Dead than Formula Fed.’

Many of the tenets of the Baby Friendly Hospital Initiative are lies. Pacifiers not only don’t interfere with breastfeeding, they prevent SIDS. Judicious formula supplementation not only doesn’t reduce the likelihood of breastfeeding success, it actually increases it. Locking up formula in hospitals doesn’t improve breastfeeding rates, but it does increase the psychological distress of women who can’t or don’t wish to breastfeed.

Lactivist dishonesty is particularly deadly not simply because lactation professionals lie to patients, but because they lie to each other. Lactation consultants are ostensibly medical providers and like all medical providers, they are responsible for preventing, diagnosing and managing medical problems.

There’s an aphorism about diagnosis that has relevance for all providers: ‘what is rare is rare and what is common is common.’

That’s what’s known as a heuristic:

…any approach to problem solving, learning, or discovery that employs a practical method not guaranteed to be optimal or perfect, but sufficient for the immediate goals.

Heuristics are short cuts to diagnoses. Brain tumors are rare; tension headaches are common. When a patient complains of a headache, it’s much more like to be a simple tension headache, not a brain tumor. Sure some people with headaches will have brain tumors, but that represents only a tiny percentage of people with headaches. That’s why most people who have headaches can be reassured and sent away.

In contrast when someone starts coughing up blood, odds are high that something is wrong with their lungs and they should not be simply reassured and dismissed. Doing so can easily result in missing a deadly pneumonia or a deadly lung cancer.

Imagine then if we erroneously taught providers that pneumonia and lung cancer are vanishingly rare and that patients who cough blood from their lungs should be sent home and told to call if they’re still coughing blood a few days later. Many cases of pneumonia and other serious lung ailments would undoubtedly be missed at the moment when they are easiest to treat. Providers would be falsely reassuring patients with deadly conditions because the providers themselves have no idea just how common those conditions are.

That’s precisely what is going on with lactation professionals at this moment. Because they are taught that insufficient breastmilk is rare when in fact it is quite common (affecting up to 15% of women or more), they are falsely reassuring the mothers of critically ill newborns that their babies are fine when, in truth, they are actually dying of jaundice, dehydration, starvation or all three.

Babies are dying because lactivists are lying. And lactivists are lying because they believe that telling women the truth about the risks of breastfeeding as well as the benefits may lead them to ‘fail’ at breastfeeding. But the goal of providers should never be promoting a specific process; that’s unethical. The goal should always be promoting the wellbeing of patients regardless of how that outcome is achieved.

Lying is never justified, whether it is lying about the pain of labor or the risks of breastfeeding.

Natural childbirth isn’t best. Breast isn’t best.

Honesty is best.