As a virtue ethicist, I like complicated cases, since they provide the opportunity to learn and grow. I therefore chose “An 80-Year-Old Woman Whose Son Dies from a Heart Attack” as my case (Thiroux and Krasemann), since there is no easy answer. The 80-year-old woman, Jesusita, lives in a convalescent home because of a bad heart. Her family visits regularly. However, her 50-year-old son dies suddenly of a heart attack. Her family, given her weak heart, decides not to tell her, and hospital staff agree. However, after about a week she begins to ask after her son. Having been told that he is on a very busy business trip, she still wonders why he hasn’t written at least a postcard. As times passes, she becomes increasingly upset and agitated. After three weeks, the family and staff meet and discuss what they can do now. Should they tell her the truth or make up more excuses? The hearts of this family and staff were in the right place, in that they lied to save Jesusita grief. But now their lies are going to have to increase, or they are going to have to face not only the truth of her deceased son but also the truth of their own attempt at deception. The initial problem in this situation is what makes it so interesting: The virtues of honesty and kindness conflict. Now that it is revealed that the dishonest choice ended up not being so kind after all, reevaluation must take place.
We all make mistakes in these areas because we are all only human. While we love our virtues, to be fully virtuous is rare. As Hursthouse says, “there are a number of ways of falling short of this ideal.” The best of us tend to have blind spots. In this case, the blind spot was a wishful thinking that they could continue to tell Jesusita that her son was away on business, that she would forget or somehow let it go. Jesusita is obviously not senile. I think it was more that, “it is not easy to get one’s emotions in harmony with one’s rational recognition of certain reasons for action” (Hursthouse). The other virtue at play here, then, is courage. I think the family lacked the courage to face, in a situation that was already difficult for them, telling their mother an unpleasant truth and helping her get through it. Virtue ethics provides some flexibility in our choices, and as such can be helpful in complex medical decisions (Gardiner). However, virtuous decisions require wisdom. One might think that putting heads together and determining the best course with staff might also lead to more wisdom, but in this case unfortunately it did not. Now that they know their hope for an easy answer has been shattered, perhaps some wisdom will be found.
Questions raised about this case include:
Did they do the right thing in the beginning by lying to Jesusita?
If she were your mother or grandmother, and your brother or uncle had died, what do you think she should be told? Why or why not?
If you had done what they did or if you were staff dealing with this situation, what would you advise? Do you feel she should be told the truth now? If so, how would you do the telling? If not, how would you suggest this situation be handled?
Do you think it would have been better to tell her the truth in the beginning? Why or why not? Do you think not telling her in the beginning has made the situation worse? Why or why not? If so, in what ways?
These questions are answered below:
No, they did not do the right thing by lying to Jesusita in the beginning. Of course that seems obvious now that she is upset. But in the beginning, they had to choose whether or not to abandon the virtue of truth in the face of the virtue of kindness or compassion. Was there a high enough chance that Mom would “die happy” thinking that her son was still alive? No, they were just delaying the inevitable. They are going to have to face her now and tell her what happened to her son. The virtuous person feels good being virtuous. When you hesitate to lie to Mom, when you enlist others in your lies to Mom, when you feel bad lying to Mom, your heart is telling you, you should face up to the terrible news and tell her the truth.
If she were my mother, from the beginning I would have told her, with the advice of her doctor and her priest, that her son/my brother had died. Assuming that she realizes that heart disease runs in families and middle-aged men are vulnerable, this death is not shocking even though it is sudden. I would probably end up telling her myself, because she would have a bit of warning by the grief in my face; but I would discuss with the priest the best way to break the news and ask him to be nearby to provide comfort; and I would discuss with the doctor standing by to administer medication. But I think there are reasons families gather at funerals, there is comfort in togetherness, and so this would be the kindest way to break the news. I would turn toward thoughts of a good life well lived as quickly as possible, because I think memories are consoling. It takes a little of the virtue of courage to be the one to confront the news, but if I am the best person for her to hear the news from, then it would be time to find that courage.
If I were staff, I would tell the family that she does need to hear the truth now, including the truth that we did not tell her before because we did not want to upset her. But now that she is clearly upset, we need to give her bad news. In addition to the comments above in answer to number 2, as her doctor I would make the family an offer. I would break the news and take responsibility for the decision that I went along with, wondering if her heart were strong enough to take such news. Let her anger be focused on me, to help keep her family together. They can apologize and get on with grieving together. Compassion for the mother who has lost her son and the family who has lost its way would give me the courage to take the brunt of the blow in order to keep the family together. I should have stopped this in the first place. I will take responsibility for it now, so that the family can stay together and their mother can understand what actually happened to her son, and give and receive comfort to and from her family.
It would have been better to tell her the truth in the beginning, for the reasons stated in the answer to question 1. As noted, continuing to lie would necessitate more lies and the story would grow outrageous. Clearly Jesusita knows something is wrong. If she were senile and did not know who people were anymore, might not understand what they were talking about, and really would not remember him after a short time, a lie may have been best. But this is not her case. Not telling her in the beginning has made things worse because now they will have to face not only her son’s death, but the lies of her family. Hopefully we can make her understand that it was done with the intention of not upsetting her. But this case proves that with very rare exceptions, “honesty is the best policy.” As a virtue ethicist, we do not live by rules, our wisdom can temper that policy where necessary; but this was not a good case for flexibility.
Final recommendations
My recommendations as a virtue ethicist, then, in this case, are that honesty and courage are virtues that should be tempered with wisdom in certain cases, but this was not one of those cases. While the virtue of compassion might override these others in some cases, such as an Alzheimer’s patient who has deteriorated to the point that she does not remember people, thus would be upset without understanding, here we have a woman still in possession of her mental facilities. Therefore, her family have to face her and fess up. And staff have to support them in this. Jesusita has to have a chance to express her emotions. The family has to have a chance to grieve together. Everyone involved needs to apologize, realize that Jesusita is sharper than they thought, acknowledge that they have learned their lessons, and promise to be more immediately forthcoming in the future. As mentioned in the beginning, their hearts were in the right place. But the best white lie is a very, very, rare white lie; and when trying to avoid helping another face an unpleasant truth, it must be out of real compassion, not out of your own lack of courage.
- Gardiner, P. “A Virtue Ethics Approach to Moral Dilemmas in Medicine.” Journal of Medical Ethics 29
(2003): 297-302. Web. 11 December 2015. - Hursthouse, Rosalyn. “Virtue Ethics.” The Stanford Encyclopedia of Philosophy. Stanford University,
Fall 2013. Web. 11 December 2015. - Thiroux, J.P., and K.W. Krasemann. Ethics: Theory and Practice. 10th ed. Vitalsource, 2008. Web. 11
December 2015.
