Truth Telling in Ethics

Türkiye ile AB ülkeleri arasında, AB ülkelerinin kendi içlerindeki dalgalanmadan daha büyük bir fark teşkil eden durumlar vardır. Bunların başında, tarafların farklı dinlere mensup olması ve dolayısıyla kültürlerin dinle ilintili alt bölümleri yer alır. Daha basit rahatsızlıklarda olduğu gibi, ölümcül sayılan hastalıklarda da Avrupalılara kıyasla Türk hastanın tevekkülcü bir yaklaşımla, çözüm peşinde koşmak konusunda daha az ısrarcı davrandığı ve daha az deneme yaptığı söylenebilir. Çoğu hastanın bizzat girişimci olmak yerine konuyu etrafındakilere havale etmeye eğilimli olduğu görülür. Hekime Batı toplumlarından daha fazla hikmet atfetmeye meyilli Türk hasta, karar verme sürecine daha az müdahil olarak, doktorun kendi adına karar alacağı bir tedaviyi kabul eder görünmektedir.

As we know, the pharmaceutical industry´s main purposes are 1) ceaseless sales growth, 2) profitability maximization and 3) shareholders´value creation. To achieve these aims, in 1997, for the first time in history, it won over the U.S. federal government and the U.S. Food & Drug Administration (FDA) to authorize direct-to-consumer prescription pharmaceuticals advertising (DTCPA) on TV and on the other mass media, that certainly these days, includes mobile devices, such as smart-phones. During these 21 years, Big Pharma´s DTCPA investment exhibited an unprecedented exponential growth curve and is showing a continuous upward sloping, surpassing the annual rate of increment of both direct-to-physicians promotion (DTPP) and R&D expenditures. The positive relationship between DTCPA and demand stimulation (" pull strategy ") led the industry to currently invest a total of more than u$s 6 billion per year in DTCPA in the U.S. media market, and, in the age of digital communication, it´s expected to pursue its expansion path. As a result, sensual brands of brand-name prescription drugs are so ubiquitous in today´s American urban and media landscape that they are clearly encouraging self-diagnosis, self-misdiagnosis and an upsurge of ads-based drug requests from patients to doctors that are ―in our view― distorting the indispensable characteristics of the physician-patient relationship. This resource-rich industry´s apparatus of symbolic legitimation´s discourse maintains that DTCPA is helping to: 1) enhance disease awareness, 2) educate consumers about new therapeutic options, and 3) prevent under-treatment of conditions that could receive pharmacotherapy. On the contrary, public health´s main reason of being is population health. From a public health ethics perspective, not only is the US " health " system the world´s most expensive and wasteful but, also, we observe that it´s suffering from a list of severe drawbacks that DTCPA is aggravating, such as: 1) disease mongering, 2) over-medicalization, 3) pharmaceuticalization, 4) over-use and over-utilization of resources, 5) over-testing, 6) over-diagnosis, 7) over-treatment, 8) over-prescription, 9) unnecessary care, 10) high incidence of FDA-approved post-marketing prescription drugs-induced dangerous adverse effects (Content analyses highlight that advertisers do not disclose drug risks in the same way they accentuate drug benefits, e.g.: the Vioxx case), 11) sky-high, staggeringly

À la fin du premier semestre 1982, Michel Foucault prononce à l’Université Victoria de Toronto un cycle de conférences intitulé "Dire vrai sur soi-même". Le thème de ces conférences, s’inscrivant dans le cadre du projet d’une généalogie du sujet occidental moderne, est la formation historique de l’herméneutique de soi. Après avoir analysé le type très particulier de connaissance de soi et de rapport à soi qui caractérise l’askêsis gréco-romaine, où il s’agit pour le sujet d’établir avec lui-même une relation de possession et de souveraineté, Foucault étudie le renversement qui conduit, aux premiers siècles du christianisme, et tout particulièrement dans les communautés monastiques, à la naissance d’une herméneutique de soi conçue comme l’exploration et le déchiffrement par le sujet de sa propre intériorité. Pour définir ce renversement, Foucault introduit ici une distinction inédite entre deux formes d’ascèse, l’une tournée vers la vérité, l’autre tournée vers la réalité. Parallèlement aux conférences, Foucault conduit à Toronto un séminaire consacré à l’étude détaillée de textes des auteurs anciens sur lesquels s’appuient ses analyses de la culture de soi antique. Il y présente également une esquisse des différentes significations de la notion de parrêsia dans l’Antiquité, qui allait devenir le thème principal de ses derniers travaux. Ces conférences et ce séminaire sont publiés ici pour la première fois, dans une édition critique.

In this essay, I draw inspiration from Stanley Cavell’s analysis of passionate utterance, as an enlargement of J. L. Austin’s theory of performatives, in order to discuss Michel Foucault’s study of truth telling (parresia) from an ethico-political perspective. I suggest that we should consider parresia, like passionate utterance, as a form structured around perlocutionary effect, and I show that this standpoint allows us to clarify Foucault’s analyses by identifying seven necessary conditions for parrhesiastic utterance: absence of codified effect, freedom of the individual speaking, criticism, dangerousness, courageousness, transparency, and alethurgy. This list, which does not claim to be exhaustive, turns out to be essential to distinguish parresia from other utterances that we commonly label under the rubric of truth telling.

This paper addresses three factors that have contributed to shifts in decision making in healthcare. First, the notion of patient autonomy, which has changed due to the rise of patient-centered approaches in contemporary healthcare and the re-conceptualization of physician-patient relationship. Second, the understanding of patient autonomy has broadened to better engage patient participation. Third, the need to develop cross-cultural health care ethics. Our paper shows that the shift in the West from the individual to the relational self indicates an important change in the understanding of autonomy through the lens of culture. Practices that recognize the notion of the relational self allow for a more balanced view of autonomy and a richer conception of moral agency.

This paper investigates the role of ‘truth’ as an object of contention within organizations, with specific reference to the ‘politics of truth’ in the WikiLeaks case. For an empirical illus- tration of a ‘truth game’ this paper draws on varied accounts of the WikiLeaks whistleblow- ing website. The paper shows how different ‘truth games’ are mobilised by different organi- zational actors engaged in a politics of truth. The paper demonstrates the existence of differ- ent truth games at work in the WikiLeaks case. It shows WikiLeaks’ profound challenge to hegemonic games of truth in terms of a ‘networked parhessia’, which entails a radical trans- formation of the process of truth telling in support of whistleblowers and in pursuit of an ex- plicitly emancipatory, anarchist political agenda. Networked parhessia provides a new infra- structure to enable a ‘parhessia of the governed.’ This paper demonstrates how WikiLeaks is of singular importance as a case study of organizational resistance in the way it moves be- yond micropolitical acts of resistance, such as whistleblowing, towards an engagement with wider political struggles.

This thesis is a reconstruction of the Foucauldian genealogy of parrhēsía and an analysis of its contemporary significance. It is composed of three chapters, the first two being critical reconstructions of the genealogical analysis of truth-telling, provided by Michel Foucault throughout his late lecture series at Berkeley and the Collège de France, and the third chapter reveals the contemporary significance of the discoveries found in the previous chapters. I argue that Foucault overlooked the importance of rhetoric within his genealogy and drew an inordinate dichotomy between rhetoric and parrhēsía. I suggest that rhetoric plays a vital role in the performance of parrhēsía, whereas flattery is opposed to truth-telling. The first chapter engages with the meaning of parrhēsía in Greek Antiquity and I discuss the relationship between the three forms of parrhēsía that emerge: the personal, political, and philosophical. The second chapter probes the development of truth-telling within Christianity, in which I consider truth-telling in the New Testament and the institutionalisation of what Foucault terms, “a regime of truth”. Foucault identified two factors that contribute to the Christian regime of truth, “the regime of faith” and the “regime of confession”, which I elucidate. The third chapter examines how Foucault connects the Christian regime of truth with modern governments, or what he terms, the “new pastorate”, who control using discourses of governmentality and biopolitics. I investigate how the Internet disrupted the monopolisation of truth and explore the concept of “post-truth”. I argue that the term “alternative-truths” better captures the contemporary situation because access to the truth has become far more accessible thanks to the Internet. I present the example of Edward Snowden to illustrate the parallels between contemporary whistleblowing and Greek parrhēsía and discuss how the Internet enables parrhēsíastes to continue to tell the truth from exile. Thus, I conclude with the claim that the Internet enables truth-tellers to overcome limitations that hindered parrhēsíastes from the past.

Bu tezde, Arkaik Yunan Şiirinin başlangıcından itibaren Klasik Çağ’a gelinceye kadar ad, adlandırma ve hakikat kavrayışları arasındaki ilişki genel çerçeve olarak belirlenmiş, Pindaros’un zafer şarkılarında bu sorunun ele alınışının şairin ardıllarına nasıl ışık tuttuğu çözümlenmiştir. Bu doğrultuda, “doğa” kavrayışının tarihsel seyrinin, şiirdeki yaklaşımların farklılaşmasının temel dinamiğini oluşturduğu gözlemlenmiştir. Nitekim bütünüyle fiziksel verilere dayanan Homerosçu “doğa”dan, Klasik Çağ filozoflarında tam anlamıyla siyasal ve ahlâksal bir tarz kazanan soyut bir kavram olarak “doğa”ya doğru ilerlerken, Pindaros’un şiirsel söylemesinde “doğuştan gelen” aracılığıyla geliştirdiği yaklaşımlar bu iki kutup arasında bir tür köprü oluşturmaktadır. Bu “köprü”nün ad, adlandırma ve hakikat ilişkisinin Pindaros’ta eşsiz bir şekilde ifade edilmesinde önemli bir rolü vardır. Homeros’taki adın büyüselliğinden başlayarak incelenen ve Hesiodos’un evren inşasında elverişli bir aygıt haline gelen ad(landırman)ın hakikate işaret etme tarzları bu gidişatın ilk aşaması olarak belirir. İkinci aşamada lirik şiirin çeşitlenen şiirli söyleme biçimleri ve vesileleri sayesinde ad(landırman)ın hakikatle ilişkisi soykütük temelli toplumsal çatışmalardan dinsel ritüellere, iktisadî dönüşümün getirdiği sınıfsal ayrışmadan aristokratik yergi söylemine farklı yönlerde gelişmeye devam eder. Pindaros’un “vesileye bağlı” zafer şarkılarında ise, ad(landırman)ın şiir geleneğinden miras alınan gücü, muzaffer atletin “doğuştan gelen” yanının özünü sürdürmesi amacıyla etkili bir şekilde kullanılır. Pindaros’ta ad(landırma) aslında “doğuştan gelen”i adlandırır, dolayısıyla adın tam anlamıyla ifşa edilmesi de “doğuştan gelen”in gözler önüne serilmesini, yani bireyin doğumuyla edindiği soykütüksel, toplumsal, iktisadî, ruhsal, bedensel niteliklerin tamamının ifşa edilmesi anlamına gelir. Ad(landırma) Pindaros’un şiirsel tekhnê’siyle biçimlendirdiği yeniden adlandırmayla pekiştirilir. Sonuç olarak, adın dolayısıyla “doğuştan gelen”in sophos şair tarafından yeniden adlandırılarak “hakkaniyetle” ifşa edilmesi, muzaffer atletin yanı sıra, onun mensubu olduğu ailenin, aşiretin, kent devletinin hatta bir bütün olarak Pan Hellenik toplumun hakikat alanında özünü sürdürmesinin teminatı haline gelir."

In this dissertation the relationship between name, naming and truth is defined in a general framework from the beginning of Archaic Greek Poetry until the Classical epoch, and it is analyzed how the seizure of addressing this problem shed light on the successors of Pindar in his victory odes. Accordingly, it is observed that the historical progress of the conception of “nature” is the basic dynamics of differentiation in poetry. Advancing from Homeric “nature” that is solely based upon physical data towards “nature” as an abstract concept that gained a fully political and moral style in Classical philosophers, Pindar’s approaches in his poetry, which he developed by means of “innate”, form a bridge between the aforementioned opposite poles. This “bridge” has an important role in the unique expression of the relationship between name, naming and truth in Pindar. The ways of nam(ing) in the indication of truth, which is investigated from the magic of name in Homer through Hesiod, where it becomes a convenient tool in the construction of kosmos, appears as the first phase of this course. In the second phase, the relation between nam(ing) and truth continues to develop in different directions ranging from genealogically based social conflicts to religious rituals, from class divergence brought upon by economic transformation to aristocratic satirical discourse, owing to the varied poetic utterance forms and occasions of lyric poetry. In Pindar’s “occasional” victory odes, the power of nam(ing) inherited from poetic tradition is effectively used for the victorious athlete’s “innate” side to carry on its essence. In Pindar, nam(ing) actually names the “innate”; therefore, the full exposure of the name means the exhibition of the “innate,” is the total exposure of the genealogic, social, economic, spiritual and corporal qualities of the individual that are acquired at birth. Nam(ing) is reinforced with re-naming which Pindar shapes with his poetic tekhnē. Consequently, the exposure “with righteousness” by means of re-naming of the name ergo the “innate” by the sophos poet becomes the guarantee of the continuation of the essence in the realm of truth, not only for the victorious athlete but also the family, clan and city-state to which he belongs, even the Pan-Hellenic society as a whole.

Purpose: Nurses encounter the challenge of truth-telling to patients' terminal illness (TTPTI) in their daily care activities, particularly for nurses working in the pervasive culture of family protectiveness and medical paternalism. This study aims to investigate oncology nurses' major responses to handling this issue and to explore what factors might explain oncology nurses' various actions. Methods: A pilot quantitative study was designed to describe full-time nurses' (n ¼ 70) truth-telling experiences at an oncology centre in Taipei. The potential influencing factors of nurses' demographic data, clinical characteristics, and truth-telling attitudes were also explored. Results: Most nurses expressed that truth-telling was a physician's responsibility. Nevertheless, 70.6% of nurses responded that they had performed truth-telling, and 20 nurses (29.4%) reported no experience. The reasons for inaction were " Truth-telling is not my duty " , " Families required me to conceal the truth " , and " Truth-telling is difficult for me ". Based on a stepwise regression analysis, nurses' truth-telling acts can be predicted based on less perceived difficulty of talking about " Do not resuscitate " with patients, a higher perceived authorisation from the unit, and more oncology work experience (adjusted R 2 ¼ 24.1%). Conclusions: Oncology care experience, perceived comfort in communication with terminal patients, and unit authorisation are important factors for cultivating nurses' professional accountability in truth-telling. Nursing leaders and educators should consider reducing nursing barriers for truth-telling, improving oncology nurses' professional accountability, and facilitating better quality care environments for terminal patients.

This paper is concerned with the relationship between those who are in power and the duty to tell the truth. People in power base their actions on convictions, cognitions they hold to be true. They can decide how to use those cognitions, and especially if they want to be veracious, or to lie, to be silent, to distort or manipulate the truths they personally believe. This paper aims to investigate whether those in power have a moral duty to communicate what they know (or believe) to be true, or whether there is some justification for them to lie, to say what is false, with the purpose of misleading others and gaining a relative advantage in power. In the first part, I report some interesting insights by Alexandre Koyré, who in his essay on The Political Function of the Modern Lie (1943) explains why lying is a temptation for man, and examines some traditional arguments for and against the use of lies. Koyré offers a reasoned defense of the claim that totalitarianism is the best demonstration of the corruption caused by a system based upon lying: if you choose to lie, the consequence is the most dreadful kind of power, based on the contempt of both truth and mankind. In the second part of the paper, Koyré’s insight is developed in the light of a personalist view. If we consider human beings as endowed with the dignity of rational beings, we can see that the duty to tell the truth derives from this dignity, because knowledge is necessary to man in order to make informed decisions, and therefore to act freely. Those in power, then, have a special obligation to tell the truth because of their position of superiority over other people. Consequently, this perspective helps to explain why the moral obligation to tell the truth as well as the right to know it have limits: the duty may depend, for instance, upon the kind of power you have, the characteristics of the recipient of the communication, some common good at stake, and the interest of other people involved in the situation. Therefore, if the respect due to the human person imposes a general obligation to give every human being the chance of knowing the truth concerning him/her, prudence determines how and to what extent a specific communication is due to someone, therefore whether it is morally right to tell him/her the truth

In this article I deal with the ethics of using deceptive placebos in clinical settings. In particular, I will criticise two influential positions within the current placebo debate. The first position is the one according to which deceptive placebos do not raise substantial moral concerns because they can be administered in ways that are “not transparent” and yet “not deceptive”. The second position, then, is the one of the American Medical Association (AMA) according to which the use of deceptive placebos without patients’ consent must be categorically prohibited. In what follows I argue that both views are flawed because they equally misrepresent key aspects of the morality of benevolent deception in clinical settings, and that deceptive placebos are morally permissible in exceptional cases.

The use of placebos in clinical settings raises a host of important ethical issues. On the one hand, ethical guidelines tend to categorically prohibit the clinical use of placebos because they require deception. On the other hand, a growing series of empirical studies has revealed that placebos can be clinically effective and are still widely used by health professionals. In this article we provide a synthetic overview of the ethical debate discussing (i) the ethics of deceptive placebos, (ii) the ethics of placebos without deception, and (iii) the ethics of eliciting placebo responses without administering a traditional placebo.

在福柯生命晚期， 他曾以“说真话” 为主题探讨了古希腊哲学的主体与真理模式。本文通过回应三个问题来推进当前对该话题的讨论： 第一， 福柯是怎么讨论“ 说真话” 的？ 第二， 如何在福柯总体思想框架里理解“说真话” 问题？ 第三， “说真话” 问题反映了福柯怎样的主体伦理学？ 对此， 本文的论点是： 第一， 福柯对直言的讨论侧重伦理维度， 特别是以苏格拉底式直言和犬儒主义直言为典型的伦理直言， 突出了对伦理区分原则的关注； 第二， “说真话” 问题是福柯思想脉络在晚期的一个延续性发展， 是其思想焦点的一次调整而非断裂； 第三， “说真话” 问题是福柯一以贯之发展的“不安伦理学” 的一个体现， 反映了他批判的、拒绝的、反抗的、违犯的主体观念。

Pursuing truth in the current global political climate is no easy undertaking. Truth seems to be contested on almost every front whether in social media, news outlets and/or the social discourse that surrounds us on a daily basis. The political rhetoric around " fake news " and " fact checking " has now become common lingua amongst everyday folk on the ground. What is the truth about truth? Is truth really so relativized and individualized as to be irrelevant? As we come to the close of 2017 and look forward to 2018, truth seems to be rather illusive.

This essay examines the traumas inflicted by acts of false-flag state terrorism on 11 September 2001, and their concealment by exploitation of mythicist falsifications that are endemic to our culture – while also paying particular attention to parallels between the staging of explosive demolitions for the WTC Towers and gutting of the Reichstag by Nazi incendiaries in 1933. The study culminates in a depiction – based on heuristic distinctions between natural, gnomic, alethic and personal wills – of how we become vulnerable to mythicist falsifications, and how truth-telling facilitates recovery of our moral integrity after the twin traumas of betrayal by acts of state terror, and complicity with that betrayal, have deeply compromised it.

The goal of this chapter is to combine these accounts, stories and recommendations into a coherent roadmap for guidance in the field of disclosure.

To accomplish this goal, we will begin by defining key terms, and will provide evidence that disclosure is a central part of fostering a safety culture. We will examine physician report cards and their relationship to disclosure policies.

We will address the significant gap that exists between the principle of error disclosure and actual practice. Although most of the literature on disclosure is based on in-patient adverse event occurrences, most of healthcare occurs in the ambulatory setting. We believe that the principles outlined below apply equally well to the ambulatory setting, but clearly require adapting the actual process of disclosure to accommodate the different time and location of outpatient care. This chapter will then examine the ethical, legal, and regulatory frameworks governing disclosure, and the benefits and drawbacks of disclosure.