Is It Ethical to Lie to Secure Hospital Admission?: Yes: Lying is sometimes in the patient's best interests

Physicians have a fiduciary relationship with their patients. At times, what they must do for patients comes into conflict with societal values and laws. When a physician thinks that a patient needs hospital admission, it may be necessary to falsify a diagnosis to facilitate the admission. Although this is a form of lying, it may be justified if it is in the patient's best interests. Lying is sometimes entirely justifiable and even ethical. Whether or not it is legal is irrelevant. What is legal does not always reflect what is ethical. For example, slavery and Jim Crow laws were once the norm in parts of the United States. Even though they were legal, both institutions were unethical. Conversely, the Underground Railroad was illegal and required lying, but it was ethically sound. Three criteria must be met to make it ethical to lie to get a patient admitted to a hospital. First, the patient must lack the financial autonomy and freedom to pay for his or her hospital admission. This is the case for most patients, whose options for treatment are usually restrained by limited economic resources and health insurance coverage. A physician should not lie on behalf of a patient who is autonomous and who can afford fully inclusive insurance that would pay for hospital admission. I am not suggesting that physicians should lie to get needy patients every single available hospital treatment. Some rationing of care is necessary because society's resources are finite. But admitting a patient for basic care for a few days is relatively inexpensive. Second, lying is justifiable if failing to admit the patient would have adverse consequences. Third, there should be no other viable alternative to hospital admission, such as nursing home placement or the employment of a home health aide. This is often the case because these alternatives usually require funds that many patients do not have—particularly if they are elderly—and it may take days to arrange for such alternatives. If these criteria are met, respite care and care for the “undiagnosed” are legitimate functions of a hospital. For example, an elderly patient who has pain that requires oral narcotic therapy may not meet the usual admission criteria. However, starting these sedating drugs at home instead of in a hospital could have dire consequences—the patient could fall, risking a hip fracture. Many emergency department visits and emergency hospital admissions are for social problems that could perhaps have been avoided with a planned admission for medical care.1,2 Is the physician breaking a contract with the government or insurance company by lying to admit a patient to a hospital? Perhaps, but the physician's primary contract is with the patient, not a third-party payer. Are physicians violating a social contract when they lie? Lying would break a social contract only if the medical system were a just one. But it is not. The poor and elderly suffer serious consequences as a result of their lack of access to health care. Lying for patients provides a modicum of balance in a medical system that systematically excludes these 2 groups of people. It could be argued that lying to get patients into a hospital takes money out of taxpayers' pockets. This is true, of course, but admitting these patients represents a redistribution of wealth from those who can afford it to those who cannot. Redesigning the medical care system to be just would obviate the need for lying. For now, however, justice demands that physicians sometimes lie to get required care for their vulnerable patients.