Is there an important moral distinction for medical ethics between lying and other forms of deception?

In this issue of the journal Ms Jennifer Jackson continues her defence of her thesis that whereas 'we all have a strict duty not to lie, we are not all under a duty of this kind not to deceive intentionally in ways that do not involve lying' (1). In her original paper (2) she argued against the 'common view' that deception that did not involve lying was morally no different from deception that did. If we recognise any duties at all, she claimed, 'we will surely include at least a primafacie duty not to tell lies'. By contrast we do not acknowledge any such prima facie duty against non-lying deception. As evidence of the latter she cited our daily tendency to deceive each other by, for example the wearing of make up, the hiding of baldness, feigned amusement at the feeble witticisms of others and false gratitude for unwelcome presents. The moral duty not to lie was based on the need to maintain trust, she argued, and neither trust nor fellowship within a community are threatened by public toleration of 'the many tricks of deceit we continually practise on one another ...'. Only in cases where the moral obligations of some special relationship exclude it does intentional non-lying deception involve a betrayal of trust and thus become unjust. Responding to her original paper, Dr David Bakhurst argued (3) that lying and non-lying deception were often morally equivalent and that their wrongness resulted from their infringement of patients' autonomy and or their dignity. Respect for patients' rights and dignity were 'deontological constraints' upon action, to be heeded 'regardless of the consequences'; accounts of moral obligations that were based on the consequences of not accepting such obligations were fundamentally flawed. This applied as much to Ms Jackson's own account of the moral obligation not to lie (because lying damages trust and social cohesion) as to the utilitarian account she criticised (that a moral obligation not to lie maximises welfare). For Dr Bakhurst, doctors' obligations neither to lie nor to deceive patients in other ways, stemmed from the moral obligation