【１】「死とは何であるか」、「死んだらどうなるか」ということは、じつは人間の理性では決して突き止められない問題です。いまのところ分からないというのではなくて、原理的にはっきりさせられない問題なのです。【２】人間は文明発生以来たえず、この「死んだらどうなるか」という問題に何らかの答え（物語）を与えてきました。その理由は、昔は人間が蒙昧だったからではなく、人間が「自我」の生き物であり、これが分からなければ「自我」が安定しない本性をもっているため、「死んだらどうなるか」についての物語をどうしても必要としたからです。（中略）
　【３】そのために、どんな文明、どんな時代でも、人間は死とは何かについての物語を作って、それを共同体のいちばん基本のルールにするわけです。先に言ったように、西洋では、死んだら天国（地獄）に行くとか、また仏教では人間は輪廻転生するといった物語が、これまでは死についての最大の物語（フィクション）でした。【４】ただこの死の物語は、また必ず死の不安を宥（なだ）める「救済の物語」でもあったという点が大事です。
　死の救済の物語は、要するに、「死んだら何もない」という不安を打ち消す必要があるのです。というのは、もし「死んだら何もない」ということが本当なら、それは人間の生の「意味」をまったく無化するような「真理」だからです。【５】この「真理」は、人間の「生の意味」というものをまったく「無」だと言い、そのことで、生活のさまざまな努力を「無意味」にするからです。この救済の物語は、まず第一に死の不安を打ち消し、第二に生を意味づけるようなものでなければならないのです。何といっても、この役割を最もよく果たしてきたのは宗教だったと言えます。（中略）
　【６】ところが、近代以降、この救済の物語に厄介な問題が起こってきました。近代科学や合理精神が新しい世界像の基礎となることによって、キリスト教などの世界像が、多くの人間にとって疑わしく、「信じられない」ものになってきたのです。
　【７】自然科学における地動説や進化論は言うに及ばず、哲学においても、カントやへーゲルあたりから「神の存在」は自明のものではなくなり、やがてニーチェがキリスト教の世界像にとどめを刺すことになります。【８】彼は、キリスト教における「真理」に対する誠実な態度が、近代の徹底的な無神論やニヒリズムを出現させたのだと言っていますが、まさしくその通りで、十九世紀に入ると「無神∵論」はもう人類全体にとって後戻りの効かないものになります。【９】今では、キリスト教国や仏教国でも、無神論を決定的に滅ぼすことはできない。ときどきいろんな新興宗教がブームになったりするにもかかわらず、大きく見ると宗教的世界像は徐々に滅びつつあるのです。【０】
　しかし、そうであるからと言って、人間にとって死の救済の問題は必要欠くべからざるものです。そこで、宗教に代わって、近代哲学がさまざまな形で救済の物語を作り出す努力をしました。
　たとえばヘーゲルには、個の生命は死んでも大きく見れば生命循環するという考え方があります。つまり動物は死ぬと土に帰り、土は植物の養分になり、植物はまた動物に食べられてというように、生命体の大きな連鎖があるというわけです。これは、ある意味で近代的な輪廻説だと言えます。マルクスは、人間は個として生まれてくるけれど、しかし死ぬときには「類」として死ぬと言います。つまり、人間は、死ぬときといえどもじつは決して孤独で孤立した存在として死ぬのではない、社会や歴史や人類全体の一員として死ぬんだというわけです。
　これももちろん一つの物語です。この近代的な救済の物語としての人間の類的存在性、社会的存在性は、やはり近代社会での人間の生のゲームのありようを反映しています。つまり、近代社会では、人間は生まれ落ちるやその社会の中に投げ込まれて、「社会的に」自己を実現する。そのことによって、社会や歴史の中に自分を参加させ、社会的存在、歴史的存在として自分を成就するということを目標にするのです。だから、人間は死んでも何か社会的な貢献、社会の進歩や発展に寄与するように生きれば、その「生の意味」が保証される（救われる）ことになる。
　この物語は、近代社会の中で人間のライフスタイルが社会的自己実現というゴールを持つようになったことと対応しているのです。

　（竹田青嗣「自分」を生きるための思想入門」より）

The frequently debated question, 'Should the doctor tell?', tends to carry a false implication that the doctor knows all about the patient's approaching death and the patient knows nothing. The resultant discussion and controversy is therefore often not to the point or only touches slightly upon the real problem. Doctors are far from knowing everything. Even if they have no doubt that their patients' condition will be fatal, they can rarely predict the time of death with any accuracy unless it is close at hand. Furthermore, patients are not necessarily unaware of what is happening; many have a very clear idea that they are dying.
Rather than putting a choice between telling or not telling, it would be more useful to ask other questions. Should we encourage the patient, or hide the truth from a patient who begins to speak of matters that will lead to talk of dying? How freely should we speak about it? Should we lie if we suspect patients only want to be told that all will be well? If there is a sincere willingness to know whether the illness will be fatal or not, should the patients' suppositions be confirmed? If there are no direct questions, have we a duty to tell the truth? Is it right to deny knowledge of dying to those who ask, or wrong to tell those who show no wish to know? Should we allow the awareness of dying to grow gradually, or should patients who are mortally ill know this early on, so that they may come to terms with a greater acceptance of dying? If they are to be told more openly, how should such knowledge be given? How do people react to being told? These questions, all part of that over-simplified, 'Should the doctor tell?', can have no universally accepted answer. Individuals differ and moral beliefs or current opinions will influence judgement.
There are some good reasons for speaking freely about the possibility of dying to those with fatal conditions. An ill person who strongly suspects approaching death, but is denied the least opportunity to question or discuss this, can feel cruelly isolated if the people around the patient remain silent. The patient may be surrounded by people whose every apparent word or action is designed to deny or avoid the fact that death is approaching, and therefore the patient has an awareness of being deceived. How can one gain the ease of wholly sincere talk with others if all continue to pretend that the immediate departure from life, the loss to them for ever, is just not taking place?
The view that we have a duty to inform those about to die has some support on material and spiritual grounds. If a doctor hides from a patient the fact that death is near, the person may fail to order family affairs or may start business ventures which would not be thought of if it were known that death was likely. The doctor's legal responsibility to warn the dying person appears to be a matter of debate. Most doctors, however, will bear in mind how far people need to set their affairs in order, when considering what they should tell a dying patient. Giving advice that it might be a good idea to make preparations for one's death serves more than that single function. Delicately put, it is a hint that an ill person can discuss further with the doctor if there is a wish to know more, or it is advice that can be just accepted at its face value.
The spiritual need for a person to know that death is near may well be more important than material matters in the terminal phase. Frequently the dying person suddenly turns or returns to religious beliefs. The dying person may already have prayed for help in serious illness, perhaps with a rather unfamiliar voice. If it appears that recovery is unlikely, most people in the religious world hold strongly that the patient should know this, so that preparations can be made for eternal life.
At times there is an increasing need to be frank with a patient over the prediction concerning the outcome of the disease, because there are short periods of feverish hopes followed by long periods of despairing misery. The patient may waste effort and money on unjustified and quite hopeless treatments, only to have bitter disappointment as well-known cure-alls fail. If a patient is seriously ill and appears to be getting worse while the doctors appear content with ineffective remedies, it may be felt that opportunities for a cure are being lost. This may lead to a feeling of frustration or a desperate tour of other doctors. Of course, a second opinion from a respected source may be a great help to all concerned. This may bring assurance that no important possibility is being neglected. When a troubled patient who has been seeking fruitlessly for cure comes to a better understanding with the doctor on the nature of the disease and how much hope is justifiable, confidence may be regained and greater peace found.
In spite of these arguments which favour frankness with the dying, many doctors are unwilling to speak with them of death. They feel that most patients do not wish to raise the subject except to get reassurance, and that the truth is likely to be hurtful. This common medical attitude is uncomfortably combined with a considerable hesitation over deliberately avoiding the topic and deceiving patients who have put their trust in the doctor, even if the 'white lies' are intended to avoid distress. Some doctors who speak in a direct way, however, make plain their belief that it does patients no good to be told that they are dying. It is a viewpoint easy to attack on theoretical grounds; but when truth can give rise to considerable distress, when kindly half-truths do not materially alter the course to death and when dying people would like to hear that they will recover, it takes a very convinced person to disapprove of lies, or even the occasional untruth. Many honest people who care for the dying find themselves hiding the truth in a manner they always wished to avoid.
In practice relatively few doctors tell patients that there is no hope of recovery. In one study of medical opinion, for example, a group of over two hundred doctors, working in hospital and private practice, were asked if they favoured informing those patients found to have a cancer very likely to prove fatal. Patients so defined would include, of course, some whose signs of illness were examined early while they were in reasonable general health with death some way off. Such patients might have little reason at this stage to suspect their illness to be fatal and if a doctor did tell them, it would give them some unexpected bad news. Eighty-eight per cent of these doctors would not tell the patient, although some of them would make exceptions. The doctors felt that usually the patient's questions were wishes for reassurance. The other twelve per cent usually told the patients that they had cancer especially if the latter were intelligent and emotionally stable. Most of the doctors felt that they should inform a relative and were glad to share the burden of their knowledge. By the way, no less than sixty per cent of these same doctors said that they would like to be told if they themselves had an equally fatal form of cancer. This disagreement in opinions between giving and receiving such information was explained by the doctors on the basis of their own greater strength of mind or responsibilities. It might be so, but it is more likely to be the emotionally determined attitude found among non-professional and medical people alike. This was indicated by the fact that these physicians were not any more frank with other doctors whom they treated for cancer than any other patients with cancer.
The unwillingness to admit to a sick person that an illness may be fatal is not confined to doctors. One survey of people's wishes to be told if they had cancer indicated that they themselves would prefer to be told but were less in favour of recommending that others in a similar condition should be informed. In one particular study of terminal care in Britain the relatives and friends of those who died appeared to know more and expected to be told more than the dying person about the true condition. About half of these patients were aware of their condition. Although many of those asked in this study accepted the degree of either knowing or not knowing shown by the dying, there was stronger approval of the patient not knowing than of his being aware. From a recent inquiry into the way married people deal with their partners' fatal illnesses, it appears that hardly a quarter openly discuss each other's situations even though an unspoken understanding may be' there.