Physician Abigail Zuger this week explored the ethics of lying to insurance companies when it may be in the best interest of a patient, highlighting a debate between ethicists recently published in the American Journal of Bioethics.

Writing in the New York Times' "Well," Zuger notes that patients often ask their doctors to lie to insurers, employers, or loved ones about their health. And, although medical ethicists say that physicians should not lie to patients, they disagree on whether they should lie to a third party if it would help their patient. 

In a recent issue of the American Journal of Bioethics, six ethicists debate whether physicians can—or should—lie to an insurance company if their patient's health is on the line. Specifically, should a physician give a bogus diagnosis that would allow a patient to receive a test or medication that he or she needs but that an insurer will not pay for without that diagnosis?

Nicolas Tavaglione and Samia Hurst of the Institute for Biomedical Ethics at Geneva University Medical School argue that a physician should lie in such a scenario because helping a patient live takes precedence over all other considerations. They write that telling the truth would be "honoring an ideal principle in a non-ideal world."

However, other ethicists argue that that it will become more difficult for patients to receive necessary care if too many physicians "play Robin Hood."

Moreover, University of Alabama's Thomas Huddle argues that lying—even for a good cause—erodes the moral fabric of medicine. Similarly, Medical University of South Carolina's Robert Sade says that each lie told by a physician "reinforces the habit of lying" and makes lying easier until physicians become "morally disengaged" and capable of harmful behavior (Zuger, "Well," New York Times, 4/22).