Dear Joseph,
I'm an orthopedic surgeon who recently saw as a patient a construction worker who broke his foot playing soccer with his kids. After I told him he needs to spend three months resting before returning to work, he asked that I change his medical record to reflect that his injury occurred not in his backyard, but on the job, so he can get workman's compensation. His three kids and his wife depend on his single income, and he tells me his boss will give him full support in his claim. Do I change his record to reflect this so that he can provide food for his family during his three months out of work, or is it unethical to change his record?
-- Orthopedic Surgeon

Dear Orthopedic Surgeon,
A short time after receiving your letter, I was the speaker at an event where many doctors and lawyers were present. Finding myself seated at a table with members of both professions, I mentioned your dilemma. One physician's blunt response, uniformly supported by his colleagues, impressed me as both clear and right: On legal grounds--by asking you to alter your records--this man is trying to involve you in an act of fraud. On moral grounds, the same applies. He wants you to falsify your records (lie) so he can receive benefits to which he is neither legally nor morally entitled.

The lawyers present at the conversation suggested that while they would not knowingly lie and deceive others, they would refer him to another physician, with the implicit understanding that the man misinform the physician about the true origins of his injury; that way the burden of the dishonesty would be on the head of the man with the broken foot and not on yours.

In terms of morality, it seems pretty obvious that the approach offered by the doctors with whom I discussed the case is more moral than that of the lawyers. But there is an additional consideration: the possibility, admittedly unlikely, that the insurance company learns of the fraud and pursues legal action against the man and against you. What will you say under oath? You will be forced either to perjure yourself or to confess an act of fraud. Imagine how you'd feel the night before you were to testify--or even be questioned by insurance-company officials without an oath. An old Jewish proverb teaches, "Who is wise? One who foresees the future consequences of his actions."

The way the man phrased his request--implying that his family will starve if you don't fulfill his request--sounds a bit overwrought, even exploitative. It is undoubtedly true that the man and his family will fall prey to economic pressures in the absence of workmen's comp. But he shouldn't use that to pressure you into doing something wrong. Perhaps your moral obligation in this case is to help the man with a monthly contribution of some sort, and to try and raise some money for him from others. It is fine, after all, to be generous with your own money. It is not fine to be generous with other people's money, money to which neither you nor this man are entitled.