⭐⭐⭐⭐⭐ Rejecting All Lies, By Sissela Bok

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To live without confronting the inevitability of death is not to live in anything approaching a rational or moral way. It is wrong to assume that patients prefer irrationality and moral superficiality. A death notice is a shock and a pain and yet patients can derive benefit from being told the truth even about their own death. Without the disclosure of truth in a dying situation, patients are likely to be subjected to aggressive treatments which will turn their dying into a painful, expensive and dehumanizing process. It is just this kind of situation which has contributed to increasing support for the euthanasia movement. Patients rightfully are afraid that they will not be told the truth about their medical condition and therefore will die only after futile interventions, protracted suffering, and dehumanizing isolation.

On the other hand, the benefits of being told the truth may be substantial; for example, improved pain management, even improved responses to therapy, etc. But harm too may come from telling the truth about death. Harm may be rare, but still it must be guarded against. The doctor who tells a dreadful truth must do so at a certain time, and in a certain way. The communication of truth always involves a clinical judgment. Truth telling in every clinical context must be sensitive and take into consideration the patient's personality and clinical history. Generally speaking, however, in case of doubt it is better to tell a patient the truth.

In complex clinical contexts, it may be difficult to draw the line between truthful disclosure and a violation of truth. Reasons could certainly be advanced to justify not telling a certain patient the whole truth. Outright lies, on the other hand, rarely are excusable. Something less than full and complete truth is almost inevitable. The good clinician is not just good at medicine and a decent person; he or she is also good at judging just what the principle of truth telling requires in a particular clinical context. Classical Catholic natural law tradition, beginning with Augustine 6 and continuing with Aquinas 7 and beyond, considered every instance of lying to be a sin. Lying, in this tradition, subverts the nature of speech and therefore violates the divine purpose in creating us as speaking animals.

Circumstance, intention, and consequences may mitigate its gravity but could never change the inherent evil of untruthful speech. If the intention was right and serious harm to others was avoided, then the objective evil would be much less, but lying was never a good act. This Catholic moral teaching, however, was modified by confessors who were forced to decide whether individual penitents in particular contexts had committed a sin or not. Confessors and Casuists introduced mental reservation as a way of denying the intrinsic evil of every lie.

At the end of the 18th century Kant 8 argued for truth and the strict rejection of all lying. In Kant's categorial imperative doctrine, truth telling is a duty imperative which binds unconditionally categorical. A lie is always evil for Kant because it harms human discourse and the dignity of every human person. Kant did away with mitigating circumstances, intentions and consequences. Truth telling is always a duty, whether the other has the right to know or whether innocent persons will be severly harmed.

In Natural Law theory, truth has an objective foundation in the very structure of human nature. Even in Kant, an assumption exists that lying violates an objective moral standard. In both the Catholic and the Kantian tradition, truth telling is a condito sine qua non for individual human integrity. Habitual violations of veracity robs the liar of any sense of who he or she is.

Truth telling is necessary in order to become a decent person and even to know oneself. Truth telling is even more obviously necessary in order to sustain human relations. Human beings are essentially relational, and without truthfulness human relations are impossible. Without honesty, intimacy and marriage dissolve. Without intimacy and marriage, communities cannot exist, small or large, civil or economic. Without honesty and trust, human beings are condemned to an alienating isolation. What is the case for human beings, generally speaking, is even more true for doctors who are by definition in relationships with their patients.

Truth obviously is an essential moral good. But, what if truth comes into conflict with other essential moral goods like life itself, or beneficence, or freedom? Can a lie be justified if it saves a human life or a community, or if another great evil is avoided? Were Augustine and Kant right when they admitted of no exceptions to the duty to tell the truth, or were the Confessor and Casuists right when they insisted on considering consequences, intention and circumstances, and when they considered some lies to be of little or no moral import?

Historically a doctor's benevolent lie told to a sick and worried patient was considered the least evil act of all. In fact, Casuists and Confessors considered benevolent lying to patients to be a good act. Trying to decide what to say in medical relationships or in clinical contexts is often side-tracked by phony arguments. One such argument claims that there is no moral responsibility to tell the truth because truth in a clinical context is impossible. This argument focuses on the enormous complexity of grasping and then communicating concrete medical truth in its full sense. This argument, understood in abstraction, is respectable, and yet in its application it turns out to be fallacious.

We may recognize and readily admit epistomological complexity as well as an inevitable human failure to achieve "the whole truth". But these recognitions do not make truth telling impossible and do not cancel out or even reduce the moral obligation to be truthful. The doctor who pauses thoughtfully before responding to a sick, anxious, and vulnerable patient's questions is faced with a clinical moral issue rather than a philosophical perplexity. The truth issue here is not that of inevitably limited human cognition trying to grasp the full complexity of a particular person's disease. Rather, it is the question of what to disclose of known information in order to make sure that the disclosure helps the patient or in order to keep the truth which is known from doing a vulnerable patient more harm than good.

This same idea can be expressed in different ways. Rather than speaking about epistomological vs. Objective, quantitative, scientific truth is abstract and yet it is not alien to the clinical setting. Relational, contextual, clinical truth always points toward the incorporation or application of what is objective and abstract. But the two are not synonymous or reducible one to the other. A clinical judgment is different from a laboratory judgment, and the same is true of clinical and abstract truth 9.

The clinical truth strives to address a patient's inquiries without causing the patient unnecessary harm. It cannot ignore objectivity, but is not reducible to it Besides making the distinction between epistomological and clinical truth, one needs also to look at the consequences which follow from rejecting this distinction and collapsing one into the other. If, in clinical practice, doctors operate under the assumption that truth is impossible and therefore of no concern, patients will be blatantly lied to for whatever reason. Lies will be used to benefit the doctor, the hospital, the HMO, the insurance company, the doctor's specialist friends, the free market labs in which the doctor is invested, etc. No difference would exist between communication with a competent and an incompetent doctor.

Many different parties would stand to gain from considering truth to be impossible. The only parties who would not gain are patients. If patients are ravaged as a result of collapsing the moral into the epistomological, then reasons exist for rejecting the proposition that "truth is impossible. The historical medical codes addressed issues like not doing harm, not taking life, not engaging in sexual acts, not revealing secrets, but said little or nothing about telling the truth and avoiding lies. The value of not doing harm was so strong that lying in order to avoid harm was considered acceptable, a twisted form of medical virtue.

Because communicating the truth about disease is difficult, many physicians simply discounted or ignored the moral problem of truthfulness in the doctor-patient relationship. The importance of not doing harm in effect relegated truth telling to the category of "everything else being equal, tell the truth" or "tell the truth as long as it helps rather than harms the patient. Because of the historical centrality of non-maleficence, and because telling the truth about fatal or even serious diagnoses was assumed to cause harm to the patient, physicians traditionally did not tell the truth to patients. Many moral philosophers referred to physician discourse with patients as an exception to the obligation to tell the truth. The doctor's principal moral obligation was to help and not to harm the patient and consequently, whatever the doctor said to the patient was judged by its effect on these core duties.

Today, things have changed. Beneficence and non-malifience remain basic medical ethical principles, but truth is also a medical ethical principle. The importance of truth telling in the clinical context derives from taking more seriously the patient's perspective in medical ethics. The historical justifications of lying to patients articulate the perspective of the liar, not that of a person being lied to.

In most cases people are hurt when they are deliberately deceived. This is especially true of patients. This may not have been so historically, but it is definitely true today. Today, Bacon's comment that "knowledge is power but honesty is authority," is particularly applicable to doctors. The historical absence of a truth requirement in medical ethics has much to do with the moral assumptions of ancient cultures. Paternalism in our culture is a bad word, a "disvalue," something to be avoided.

In earlier cultures it was an ideal to treat other persons as a father treats a child. Paternalism was something virtuous; the opposite was to treat the other as a slave. In early Greek culture, the good doctor or the good ruler treated the patient or the citizen as a son or daughter rather than a slave. He did what was best for the "child" but without ever asking for his or her consent. With no involvement in treatment decisions, making known the truth to a patient was less important. Because patients today can and must consent to whatever is done to them, truthful disclosure of relevant information is a legal and ethical duty.

Modern medical ethical codes reflect this shift in the importance of veracity. The code of the American Nurses Association states: "Clients have a moral right.. Even the "Principles of Medical Ethics" of the American Medical Association, in , included a reference to honesty. Similar references and recommendations have been included in sub-specialty medical codes orthopedics', surgeons', psychiatrists', obstetricians' and gynecologists'. The link between patient autonomy and veracity is characteristic of modern medical ethics and is most evident in the American Hospital Association's "Patient's Bill of Right" The requirement of honesty is clearly linked today with the patient's new legal right to give informed and free consent or refusal of treatment.

In requiring adequate information for decision making, modern medical ethics broke with the paternalistic tradition. Traditionally the doctor did not tell the truth lest the patient be harmed. Now, not to harm the patient requires in most instances that patients be truthfully informed and then invited to participate in clinical decision making. If today a physician decides, in light of clinical considerations, to conceal the truth, he or she must bear the burden of proof.

A doctor must be able to defend this decision before other professional persons involved in the patient's care. And some member or members of the patient's moral community must be given the truth. If physicians habitually lie, or conceal truth from patients, they cannot be excused based on a clinical context or a discrete clinical judgement. If providing truthful information to a patient is a matter of judgment, mistakes are bound to be made. If the information itself is limited and the amount to be disclosed must be determined by the context of each case, then inevitably there will be inadequacies and failures. It is one thing to fail, to make a mistake, to miscalculate what should have been said.

It is quite another thing, to set out to lie. It is even worse to adopt a pattern of deception. Failure is one thing, becoming a liar is quite different, something incompatible with being a professional. For a true professional, striving to become an honest person is important. We have seen the strong stand of Immanuel Kant on this issue. Now listen to the person against whom Kant was most often pitted against and with whom he most often disagreed, John Stuart Mill. In the following quote, he is talking about the feeling of truthfulness or veracity.

He said that his feeling is. For Mill, if someone as much as diminishes reliance on another persons' truthfulness, he or she is that person's enemy. Because to lose the trust of others is to lose one's own integrity. A doctor can do even greater harm because not being honest damages the climate of trust within the profession. Then, it is not an individual's integrity, but a whole profession's integrity that is lost. If patients are habitually lied to or misinformed or deceived, then the context of medical practice is polluted. The whole profesion is discredited. A recent American movie, Liar Liar, attempted to make a comedy out of the all-pervasiveness of lying in the legal profession. The film makers seemed most interested in creating laughter but in the process made a not at all funny commentary on how lying and deceit have become pervasive among lawyers.

Without lying, the main character could not function in the court system. His lawyer colleagues were repugnant characters. The comic star of the movie saved his life and his marriage and his moral integrity by discovering the importantce of being truthful. Consequently, he had to seek a different type of work. The image of the legal profession portrayed in this film was sickening. We cannot let this happen to doctors and medical researchers. Something similar must not happen to doctors and the medical profession. Now, more than ever, patients have to be able to trust their doctors and to be able to rely on the truth of what they are told.

Since truthfulness and veracity are such critical medical virtues, doctors have to work to develop the virtue of truthfulness. This is not an easy task. To become a truthful person we have to struggle first to know the truth. Then we have to struggle with personal prejudices which can distort any information we gather. We have to try to be objective. We have to work to correct a corrupting tendency to confuse one side of a story or one perspective of an event with the whole truth. And, finally, we have to recognize that self-aggrandizement corrupts the capacity to know the truth and to communicate anything except pathological, narcissistic interests.

Truth for an egoist is reduced to what promotes his ego. The egoist cannot see the truth and therefore cannot tell it. The only thing which can be communicated is his or her own aggrandized self. Knowing the truth and telling the truth is difficult enough without shadowing weak human capacities for virtues with narcissistic pathological shades. If we are self-deceived we cannot hope to avoid deception in what we disclose. Not to address pathological character distortions is to make lies inevitable. The classical medical ethical codes were preoccupied with a good physician's personal character traits--rightfully so. The presumption is always for truth and against lying. But the arguments support the need to make humane clinical judgments about what is told, when, how, and how much.

Perhaps the best way to sum up the argument is to quote a sensitive and humane physician on this topic: Dr. Cicely Saunders, the founder of the Hospice movement. Every patient needs an explanation of his illness that will be understandable and convincing to him if he is to cooperate in his treatment or be relieved of the burden of unknown fears. This is true whether it is a question of giving a diagnosis in a hopeful situation or of confirming a poor prognosis.

The fact that a patient does not ask does not mean that he has no questions. One visit or talk is rarely enough. It is only by waiting and listening that we can gain an idea of what we should be saying. Silences and gaps are often more revealing than words as we try to learn what a patient is facing as he travels along the constantly changing journey of his illness and his thoughts about it. So much of the communication will be without words or given indirectly.

This is true of all real meetings with people but especially true with those who are facing, knowingly or not, difficult or threatening situations. It is also particularly true of the very ill. The main argument against a policy of deliberate, invariable denial of unpleasant facts is that it makes such communication extremely difficult, if not impossible. Once the possibility of talking frankly with a patient has been admitted, it does not mean that this will always take place, but the whole atmosphere is changed. Probably the most famous reductionist view of privacy is one from Judith Jarvis Thomson Noting that there is little agreement on what privacy is, Thomson examines a number of cases that have been thought to be violations of the right to privacy.

On closer inspection, however, Thomson believes all those cases can be adequately and equally well explained in terms of violations of property rights or rights over the person, such as a right not to be listened to. Those rights in the cluster are always overlapped by, and can be fully explained by, property rights or rights to bodily security. Privacy is derivative in its importance and justification, according to Thomson, as any privacy violation is better understood as the violation of a more basic right. Richard Posner also presents a critical account of privacy, arguing that the kinds of interests protected under privacy are not distinctive. Moreover, his account is unique because he argues that privacy is protected in ways that are economically inefficient.

Focusing on privacy as control over information about oneself, Posner argues that concealment or selective disclosure of information is usually to mislead or manipulate others, or for private economic gain, and thus protection of individual privacy is less defensible than others have thought because it does not maximize wealth. In sum, Posner defends organizational or corporate privacy as more important than personal privacy, because the former is likely to enhance the economy.

Another strong critic of privacy is Robert Bork , whose criticism is aimed at the constitutional right to privacy established by the Supreme Court in Bork views the Griswold v. Connecticut decision as an attempt by the Supreme Court to take a side on a social and cultural issue, and as an example of bad constitutional law. Douglas and his majority opinion in Griswold. Douglas had argued, however, that the right to privacy could be seen to be based on guarantees from the First, Third, Fourth, Fifth, and Ninth Amendments.

Taken together, the protections afforded by these Amendments showed that a basic zone of privacy was protected for citizens, and that it covered their ability to make personal decisions about their home and family life. In contrast, Bork argues i that none of the Amendments cited covered the case before the Court, ii that the Supreme Court never articulated or clarified what the right to privacy was or how far it extended, and he charges iii that the privacy right merely protected what a majority of justices personally wanted it to cover. In sum, he accuses Douglas and the Court majority of inventing a new right, and thus overstepping their bounds as judges by making new law, not interpreting the law.

Theorists including William Parent and Judith Thomson argue that the constitutional right to privacy is not really a privacy right, but is more aptly described as a right to liberty. If so, then liberty is a broader concept than privacy and privacy issues and claims are a subset of claims to liberty. In support of this view, philosophical and legal commentators have urged that privacy protects liberty, and that privacy protection gains for us the freedom to define ourselves and our relations to others Allen, ; DeCew, ; Reiman, , ; Schoeman, , A moving account supporting this view—understanding privacy as a necessary and an indispensable condition for freedom—comes from literature, here a quotation from Milan Kundera.

There is more detailed evidence that privacy and liberty are distinct concepts, that liberty is a broader notion, and that privacy is essential for protecting liberty. We have many forms of liberty that do not appear to have anything to do with what we might value as private and inappropriate for government intervention for personal reasons. Bell , U. It is clear that the U. Roe , U. There is no single version of the feminist critique of privacy, yet it can be said in general that many feminists worry about the darker side of privacy, and the use of privacy as a shield to cover up domination, degradation and abuse of women and others.

Many tend to focus on the private as opposed to the public, rather than merely informational or constitutional privacy. If distinguishing public and private realms leaves the private domain free from any scrutiny, then these feminists such as Catharine MacKinnon are correct that privacy can be dangerous for women when it is used to cover up repression and physical harm to them by perpetuating the subjection of women in the domestic sphere and encouraging nonintervention by the state.

But, Elshtain points out, this alternative seems too extreme. A more reasonable view, according to Anita Allen , is to recognize that while privacy can be a shield for abuse, it is unacceptable to reject privacy completely based on harm done in private. A total rejection of privacy makes everything public, and leaves the domestic sphere open to complete scrutiny and intrusion by the state.

Yet women surely have an interest in privacy that can protect them from state imposed sterilization programs or government imposed drug tests for pregnant women mandating results sent to police, for instance, and that can provide reasonable regulations such as granting rights against marital rape. Narrow views of privacy focusing on control over information about oneself that were defended by Warren and Brandeis and by William Prosser are also endorsed by more recent commentators including Fried and Parent In addition, Alan Westin describes privacy as the ability to determine for ourselves when, how, and to what extent information about us is communicated to others Westin, Perhaps the best example of a contemporary defense of this view is put forth by William Parent.

Parent explains that he proposes to defend a view of privacy that is consistent with ordinary language and does not overlap or confuse the basic meanings of other fundamental terms. He defines privacy as the condition of not having undocumented personal information known or possessed by others. Parent stresses that he is defining the condition of privacy, as a moral value for people who prize individuality and freedom, and not a moral or legal right to privacy. Personal information is characterized by Parent as factual otherwise it would be covered by libel, slander or defamation , and these are facts that most persons choose not to reveal about themselves, such as facts about health, salary, weight, sexual orientation, etc.

Thus, once information becomes part of a public record, there is no privacy invasion in future releases of the information, even years later or to a wide audience, nor does snooping or surveillance intrude on privacy if no undocumented information is gained. In cases where no new information is acquired, Parent views the intrusion as irrelevant to privacy, and better understood as an abridgment of anonymity, trespass, or harassment. Furthermore, what has been described above as the constitutional right to privacy, is viewed by Parent as better understood as an interest in liberty, not privacy. It is too narrow an account because he only allows for a descriptive and not a normative use of the term. As another example, if personal information is part of the public record, even the most insidious snooping to attain it does not constitute a privacy invasion.

Bloustein argues that there is a common thread in the diverse legal cases protecting privacy. Respect for these values is what grounds and unifies the concept of privacy. Using this analysis, Bloustein explicitly links the privacy rights in tort law described by Prosser with privacy protection under the Fourth Amendment. The common conceptual thread linking diverse privacy cases prohibiting dissemination of confidential information, eavesdropping, surveillance, and wiretapping, to name a few, is the value of protection against injury to individual freedom and human dignity.

Invasion of privacy is best understood, in sum, as affront to human dignity. Although Bloustein admits the terms are somewhat vague, he defends this analysis as conceptually coherent and illuminating. A more common view has been to argue that privacy and intimacy are deeply related. On one account, privacy is valuable because intimacy would be impossible without it Fried, ; Gerety ; Gerstein, ; Cohen, Fried, for example, defines privacy narrowly as control over information about oneself. Privacy is valuable because it allows one control over information about oneself, which allows one to maintain varying degrees of intimacy. Indeed, love, friendship and trust are only possible if persons enjoy privacy and accord it to each other.

In this way, privacy is also closely connected with respect and self respect. Gerstein argues as well that privacy is necessary for intimacy, and intimacy in communication and interpersonal relationships is required for us to fully experience our lives. Intimacy without intrusion or observation is required for us to have experiences with spontaneity and without shame. Julie Inness has identified intimacy as the defining feature of intrusions properly called privacy invasions. Inness argues that intimacy is based not on behavior, but on motivation. She believes that intimate information or activity is that which draws its meaning from love, liking, or care. A number of commentators defend views of privacy that link closely with accounts stressing privacy as required for intimacy, emphasizing not just intimacy but also more generally the importance of developing diverse interpersonal relationships with others.

On his view, privacy is necessary to maintain a variety of social relationships, not just intimate ones. Privacy accords us the ability to control who knows what about us and who has access to us, and thereby allows us to vary our behavior with different people so that we may maintain and control our various social relationships, many of which will not be intimate. Our ability to control both information and access to us allows us to control our relationships with others.

Hence privacy is also connected to our behavior and activities. Another group of theorists characterize privacy in terms of access. Some commentators describe privacy as exclusive access of a person to a realm of his or her own, and Sissela Bok argues that privacy protects us from unwanted access by others — either physical access or personal information or attention. Ruth Gavison defends this more expansive view of privacy in greater detail, arguing that interests in privacy are related to concerns over accessibility to others, that is, what others know about us, the extent to which they have physical access to us, and the extent to which we are the subject of the attention of others.

Thus the concept of privacy is best understood as a concern for limited accessibility and one has perfect privacy when one is completely inaccessible to others. Privacy can be gained in three independent but interrelated ways: through secrecy, when no one has information about one, through anonymity, when no one pays attention to one, and through solitude, when no one has physical access to one.

Carefully reviewing these various views, Anita Allen also characterizes privacy as denoting a degree of inaccessibility of persons, their mental states, and information about them to the senses and surveillance of others. She views seclusion, solitude, secrecy, confidentiality, and anonymity as forms of privacy. She also urges that privacy is required by the liberal ideals of personhood, and the participation of citizens as equals. This is in part because Allen emphasizes that in public and private women experience privacy losses that are unique to their gender. Noting that privacy is neither a presumptive moral evil nor an unquestionable moral good, Allen nevertheless defends more extensive privacy protection for women in morality and the law.

Using examples such as sexual harassment, victim anonymity in rape cases, and reproductive freedom, Allen emphasizes the moral significance of extending privacy protection for women. In some ways her account can be viewed as one reply to the feminist critique of privacy, allowing that privacy can be a shield for abuse, but can also be so valuable for women that privacy protection should be enhanced, not diminished. According to Moore, privacy is a culturally and species relative right to a level of control over access to bodies or places and information.

While defending the view that privacy is relative to species and culture, Moore argues that privacy is objectively valuable — human beings that do not obtain a certain level of control over access will suffer in various ways. Moore claims that privacy, like education, health, and maintaining social relationships, is an essential part of human flourishing or well-being. There is a further issue that has generated disagreement, even among those theorists who believe privacy is a coherent concept. The question is whether or not the constitutional right to privacy, and the constitutional privacy cases described involving personal decisions about lifestyle and family including birth control, interracial marriage, viewing pornography at home, abortion, and so on, delineate a genuine category of privacy issues, or merely raise questions about liberty of some sort.

Among the others who take this view are Henkin , Thomson , Gavison , and Bork Allen defines privacy in terms of access and excludes from her definition protection of individual autonomous choice from governmental interference, which she terms a form of liberty. Ultimately she believes interference with decisions involving procreation and sexuality raise the same moral concerns as other privacy intrusions, offending the values of personhood. The Supreme Court now claims Whalen v. Following this sort of reasoning, a number of theorists defend the view that privacy has broad scope, inclusive of the multiple types of privacy issues described by the Court, even though there is no simple definition of privacy.

Most of these theorists explore the links between the types of privacy interests and the similarity of reasons for valuing each. Some stress that privacy is necessary for one to develop a concept of self as a purposeful, self determining agent. Privacy enables control over personal information as well as control over our bodies and personal choices for our concept of self Kupfer, Privacy provides protection against overreaching social control by others through their access to information or their control over decision making Schoeman, These three interests are related because in each of the three contexts threats of information leaks, threats of control over our bodies, and threats to our power to make our own choices about our lifestyles and activities all make us vulnerable and fearful that we are being scrutinized, pressured or taken advantage of by others.

Privacy has moral value because it shields us in all three contexts by providing certain freedom and independence — freedom from scrutiny, prejudice, pressure to conform, exploitation, and the judgment of others. Yet it has been difficult for philosophers to provide clear guidelines on the positive side of understanding just what privacy protects and why it is important. There has been consensus that the significance of privacy is almost always justified for the individual interests it protects: personal information, personal spaces, and personal choices, protection of freedom and autonomy in a liberal democratic society.

Allen, ; Moore, ; Reiman ; Roessler, Schoeman eloquently defended the importance of privacy for protection of self-expression and social freedom. More recent literature has extended this view and has focused on the value of privacy not merely for the individual interests it protects, but also for its irreducibly social value. Concerns over the accessibility and retention of electronic communications and the expansion of camera surveillance have led commentators to focus attention on loss of individual privacy as well as privacy protection with respect to the state and society Reiman, ; Solove, ; Nissenbaum, Privacy is a common value in that all individuals value some degree of privacy and have some common perceptions about privacy.

Privacy is also a public value in that it has value not just to the individual as an individual or to all individuals in common but also to the democratic political system. Instead, privacy protects the individual because of the benefits it confers on society. Solove believes privacy fosters and encourages the moral autonomy of citizens, a central requirement of governance in a democracy. One way of understanding these comments, that privacy not only has intrinsic and extrinsic value to individuals but also has instrumental value to society, is to recognize that these views develop from the earlier philosophical writings Fried ; Rachels, ; Schoeman; , on the value of privacy in that it heightens respect for individual autonomy in decision-making for self-development and individual integrity and human dignity, but also enhances the value of privacy in various social roles and relationships that contribute to a functioning society.

According to this contemporary scholarship, privacy norms help regulate social relationships such as intimate relations, family relationships, professional relationships including those between a physician and a patient, a lawyer or accountant and a client, a teacher and a student, and so on. Thus privacy enhances social interaction on a variety of levels. Schoeman points out that the question of whether or not privacy is culturally relative can be interpreted in two ways. One question is whether privacy is deemed valuable to all peoples or whether its value is relative to cultural differences. A second question is whether or not there are any aspects of life that are inherently private and not just conventionally so.

Most writers have come to agree that while almost all cultures appear to value privacy, cultures differ in their ways of seeking and obtaining privacy, and probably do differ in the level they value privacy Westin, ; Rachels, Allen and Moore are especially sensitive to the ways obligations from different cultures affect perceptions of privacy. There has been far less agreement on the second question. Thus it may well be that one of the difficulties in defining the realm of the private is that privacy is a notion that is strongly culturally relative, contingent on such factors as economics as well as technology available in a given cultural domain.

The earliest arguments by Warren and Brandeis for explicit recognition of privacy protection in law were in large part motivated by expanding communication technology such as the development of widely distributed newspapers and multiply printed reproductions of photographs. Similarly Fourth Amendment protection against search and seizure was extended later in the twentieth century to cover telephone wiretaps and electronic surveillance. It is clear that many people still view privacy is a valuable interest and realize it is now threatened more than ever by technological advances. There are massive databases and Internet records of information about individual financial and credit history, medical records, purchases and telephone calls, for example, and most people do not know what information is stored about them or who has access to it.

The ability for others to access and link the databases, with few controls on how they use, share, or exploit the information, makes individual control over information about oneself more difficult than ever before. There are numerous other cases of the clash between privacy and technology. Consider the following new technologies. Caller ID, originally designed to protect people from unwanted calls from harassers, telemarketers, etc. There is widespread mandatory and random drug testing of employees and others, and the Supreme Court has said policies requiring all middle and high school students to consent to drug testing in order to participate in extracurricular activities does not violate the Fourth Amendment, although the Court has disallowed mandatory drug tests on pregnant women for use by police.

It had seemed that heat sensors aimed at and through walls to detect such things as growing marijuana would be acceptable. However in in Kyllo v. Surveillance photos are commonly taken of those using Fast Lane, resulting in tickets mailed to speeding offenders, and similar photos are now taken at red lights in San Diego and elsewhere, leading to surprise tickets. Face scanning in Tampa, at casinos, and at large sporting events such as the Super Bowl, matches those photos with database records of felons, resulting in the capture of multiple offenders on the loose but also posing privacy issues for other innocents photographed without their knowledge.

Some rental car drivers are now tracked by Global Positioning System GPS satellites, enabling car rental companies, not police, to levy stiff fines for speeding. Immigration officials in Australia are considering proposals to tag asylum seekers with electronic trackers before sending them into the community to await hearings. The media has recently uncovered an FBI Web surveillance system called Carnivore, that appears to sample the communications of as many Internet users as it chooses, not just suspects. Echelon is a covert global satellite network said to have the ability to intercept all phone, fax, and e-mail messages in the world, and may have up to 20 international listening posts.

Airline passengers will soon be able to go through customs with a two second biometric scan that confirms identity by mapping the iris of the eye, and U. There is a proliferation of biometric identification using faces, eyes, fingerprints, and other body parts for identifying specific individuals, and the technology for matching the information with other databases is advancing quickly.

Anton Alterman discusses various privacy and ethical issues arising from expanding use of biometric identification. For more on some of the other issues noted above, see other articles in Ethics and Information Technology 5, 3 For some cases in the clash between privacy and advancing technologies, it is possible to make a compelling argument for overriding the privacy intrusions. Drug and alcohol tests for airline pilots on the job seem completely justifiable in the name of public safety, for example. With the development of new and more sophisticated technology, however, recent work on privacy is examining the ways in which respect for privacy can be balanced with justifiable uses of emerging technology Agre and Rotenberg, ; Austin, ; Brin, ; Etzioni, , and Ethics and Information Technology , 6, 1, Daniel Solove takes seriously the criticism that privacy suffers from an embarrassment of meanings and the concern that new technologies have given rise to a panoply of new privacy harms.

He then endeavors to guide the law toward a more coherent understanding of privacy, by developing a taxonomy to identify a wide range of privacy problems comprehensively and completely. Moore argues that privacy claims should carry more weight when in conflict with other social values and interests. For example, he defends the view that employee agreements that undermine employee privacy should be viewed with suspicion, and he argues that laws and legislation prohibiting the genetic modification of humans will unjustifiably trample individual privacy rights Moore, He also defends the view that free speech and expression should not be viewed as more important than privacy Moore,

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