With A Loud Ethics Voice:"Physicians Are Always Physicians"
"!$#% it!" We are different than other professions or occupations!
As physicians, we are different and I think that this difference can be
documented by our history as a profession and by the privileges given to us by
society and by simple moral concepts.
We are physicians at all times.. not part time.. but at all times. We have
taken an oath when we became physicians and we are always responsible to that
oath and our professional standards.And we are physicians even when we
interact with society but have not established a doctor-patient therapeutic
relationship with a person or persons.And we never, as physicians, wear two hats! Our attention to the ethical and professional standards of being a physician never changes. Those physicians who enter other roles such as politics, forensic psychiatry or become members of the armed forces cannot ignore this fact.
The article "When Doctors Go To War" by Bloche and Marks in the Jan 6,
2005 issue of the New England Journal of Medicine, based on personal research, describes the conflicting
activities of physicians in Iraq and Guantanamo Bay including failure to
report possible torture and also to participate in the interrogation process. These
activities could be found to be contrary to medical professional ethics and
contrary to the Geneva Conventions. They describe the military's response to
these concerns pointing to "civilian parallels, including forensic psychiatry
and occupational health." The military argues, "that the medical profession
sometimes serves purposes at odds with patient welfare… the Hippocratic ideal of
undivided loyalty to patients fails to capture the breadth of the profession's
social role. This role encompasses the legitimate needs of the criminal and
civil justice systems, employer's concerns about workers' fitness for duty,
allocation of limited medical resources, and protection of public health." Bloche
and Marks argue that "the proposition that doctors who serve these social
purposes don't act as physicians is self-contradictory. Their
'physicianhood'---encompassing technical skill, scientific understanding, a caring ethos and cultural authority---is the reason they are called upon to assume these roes… and the military physician's contributions to interrogation-to it's
effectiveness, lawfulness and social acceptance in a rights-respecting society-arise from his or her psychological insight, clinical knowledge, and perceived humanistic
I have agreed with some ethicists about the lack of a strong
and persistent public voice and action by ethicists regarding the society's
inadequate active attention and correction of the problems of the poor and those
without adequate medical care within the United States and throughout the
world. Maybe this lack is due to our thinking about the complexity of the issue
and the lack of a simple solution.
On the other hand, with regard to the physician conflicts as
described in this posting, the solution is not complex and is very simple. Instead of ethicists talking to each other about the issue of physician's wearing "two hats", we should publicly, together, though bioethics and medical organizations, and with the loudest voice possible, make it clear to all in society that physicians are physicians at all times and under all circumstances and that anything less is unethical and not acceptable. I think that this simple declaration is all that is necessary. If this concept is made clear, perhaps systems in society which call on physicians to participate and have not as yet understood will finally understand what
behavior is ethical and not. …Maurice.
For additional commentary related to this topic, if you haven’t already read the previous postings, you may wish to scroll down to Thursday December 23 and the first posting of Thursday December 16, 2004. In addition, I placed links to my sources regarding forensic psychiatry and the responsibilities of a military physician