The use and abuse of deception.

Abstract

An article in this issue reports on a research project that used pseudo patients to evaluate the quality of care.' Two fundamental questions are raised: When, if ever, is the use of deception in research morally justified? How useful is research involving deception in adding to knowledge? The issue of deception in research is neither new nor undiscussed. Many recent articles have examined the ethical questions it raises. This widespread concern with deception undoubtedly reflects a basic conviction: that deception is morally hard to justify, even or especially in the pursuit of the truth. Widespread also is concern with untoward consequences of deception in research when harm is done to subjects in the experiment. Harm is done to experimenters as well by distorting their value system and the value system of their students. As Sissela Bok has pointed out,2 the physician-patient relationship is predicated on trust, and anything which undermines that basic relationship damages the care of patients. This is true for both the patient and the physician, since the physician is just as dependent on the patient (for a truthful history and for cooperation in care) as is the patient