Are Physicians to Serve as Moral Gatekeepers?
Are physicians to serve as moral gatekeepers? This question is nicely dissected, particularly in reference to the actions of cosmetic surgeons, in an article in the May 2010 issue of the Virtual Mentor by Jordan Amadio who by now has received his Doctor of Medicine degree from Harvard Medical School. Go to the link and read the article.
Beyond the individual patient for whom the patient’s physician has the fiduciary responsibility to attend and provide the patient the best and most beneficent advice and skills, there looms society. Society is the medium in which the physician must live and flourish along with his or her patient and which can have profound effects on both. And the question arises, when a physician attends the patient should the physician also consider the impact of what he or she is advising or doing upon society both in moral, practical and financial impacts? The latter two has recently been of concern because of the limits of resources and funding.
The moral aspect of what the physician decides and does has also important social implications. The matter of cosmetic surgery is considered in the article as, in many cases, a way the physician is reshaping societal views of what is considered normal, unpleasant, beautiful in personal appearance. And, perhaps, to make the ethical issue worse, physicians have become complicit (and being paid by the patient to be complicit) in resetting the societal views. Other areas of moral impact on society involves contraception, abortion, assisted reproduction, homosexuality, sexual identification as well as other non-reproductive or sexual areas such as gun control, death penalty, relations between physicians and suspected terrorists, end-of-life issues, physician-assisted suicide and organ transplantation, genetic screening and genetic mutation of plants, animals and perhaps humans. The question arises, as to how energetic or activistic should physicians become in their moral views and through their actions.
Moral and political views may merge. A recent example, written up in the national news, of a physician becoming almost a literal gatekeeper was that of a Florida urologist, Jack Cassell, who posted a sign on his office door allegedly reading, "If you voted for Obama ... seek urologic care elsewhere. Changes to your health care begin right now, not in four years."
What are your thoughts about personal gatekeeper roles of physicians in their position as professionals and by their voices and actions regarding moral issues and altering the way society looks at itself and behaves? Or should, ideally, physicians simply attend to the personal needs of their patients, suppressing moral concerns and dismiss worries regarding the effect on society in general? ..Maurice.
posted by Maurice Bernstein, M.D. @ 8:37:00 PM
6 comments
6 Comments:
Hello Maurice: The question you pose can be answered straightforwardly:Not a chance. Physicians should not be asked to wear two hats. Physicians must not act on behalf of some perceived socio-political-economic view any more than a tax attorney should consider what's best for the IRS. If a physician does in fact something injurious to a patient, society already has a system in place that provides in-depth study and consideration by a representative community group, chosen in an impartial fashion: namely by a jury, who has the benefit of testimony from expert physicians. It is they who speak on behalf of the community. Or, if there is widespread misuse of e.g., surgical practices, then the Medical Board or Department of Health may begin an investigation.
All the best Bernard
No way!!!! When doctors do moral decisions on our behalf, they´re usually wrong. Besides, what decisions they make are all too often tinged by their own religious or political ideas... Didn´t physicians in Hitler´s time gibe ominous advice on eugenics and racial purity??? And wasn´t it the case that psychiatrists used to recommend marriage to cure your emotional problems?
I want to echo Bernard's and anon's sentiments: no bleeping way. I'm not much of an absolutist about medical ethics issues but this seems to me to be a bright line that physicians shouldn't even consider crossing. I read the story about Dr. Cassell's little stunt and thought he deserved censure from the state medical board. Did he even begin to think about how this could influence the free flow of communication between him and Obama-supporting patients, how it could negatively impact the physician-patient dynamic?
There's not just Dr. Cassell. Far worse is when physicians don't merely announce their views but impose them on their patients. Take the case of Dr. Michelle Phillips of San Antonio, who used the "Provider Conscience Rule" (a parting executive order by President Bush) to refused to prescribe contraceptive pills to, and I am not making this up, unmarried women. Apparently her biblical world view does not allow her to prescribe medications that she believes smacks of immoral behavior. Does this mean that she allows adulterous married women access to the good stuff? Does she give a quiz to patients to measure their moral worthiness? (Obama overturned the rule not long after taking office, but the story I think illustrates the lengths to which some doctors can go when given free rein in terms of their personal philosophies).
So, in short, a very bad idea for docs to make medical decisions based on individual moral positions.
Why should the profession of: Physician be any different?
If a doctor chooses to work at a public hospital where he/she has no say in being selective about patients. Well, then that doctor has chosen to treat the patient REGARDLESS of his/her own culture/code/ethics and is bound by law to treat all patients.
This SHOULD mean that this doctor has accepted that they will be REQUIRED to treat patients with differing views (political/religious/moral). So if a woman comes in and requests 'the morning after pill', this doctor should have NO RIGHT to refuse this request. In fact, other than TRUTHFULLY explaining the drugs usage and any associated risks and MAYBE offering a handful of pamphlets on all OPTIONS (including counseling, adoption, etc) ... he/she should NOT be discussing or moralizing or in any way trying to INFLUENCE the patient.
What about abortions? Well, again if a doctor chooses to take a job where this would be done ... then he/she has taken the job and therefore contractually accepted that he/she would perform ALL duties of that job.
It is quite simple, but no one likes the ramifications (especially doctors).
If you choose to become a doctor, but are against the use of certain medications or doing certain procedures because they violate your beliefs ... well then you have in effect chosen to limit yourself to private facilities that share your beliefs OR creating your own such practice.
If you don't want to deal with all these implications, either you chose the WRONG profession or you need to specialize in something that isn't likely to raise much issue (like podiatry, or opthamology or whatever).
I just don't understand how any court can allow such things as doctors choosing NOT to do their job because they are morally against it. We all face things in our job we may not like, or may even be opposed to, but if we choose to remain with that employer we must do what the job entails OR be fired ... regardless of what your title may be.
One thing I have seen on other blog is what about Muslim women who become doctors... as they are not to be alone with or see the bodies of non-related men (It's not this generic, but will serve for an example). If that isn't a call for becoming an OB/GYN I don't know what is. Pediatrics is also an option since the rule doesn't include male children.
The point is that a doctor is not some holy grail of all positions that put them ABOVE others in ANY way. They have specific training THAT IS ALL - not some anointed moral and ethical code. To believe otherwise is to set yourself up for disappointment and often litigation.
Suze, I'm in general agreement with your thoughts, but you've said at least three things here that are at least artless and potentially highly misleading.
You note that "it is quite simple, but no one likes the ramifications (especially doctors)," where "it" means physicians checking their own personal moral values at the door. As a practicing physician who speaks with many colleagues about these kinds of issues on a daily basis, I'd beg to differ. In medical schools physicians are taught to treat patients without being morally judgmental, and the vast majority of the profession has taken these teachings to heart. I have never seen a physician, for instance, who has refused treatment to an IV drug addict with an infection at his or her shooting site simply because they regarded it as immoral, or for that matter because they knew that they'd most likely be treating that same addict weeks or months later. So your quip that we doctors especially have a problem doesn't ring true. Sorry.
You then say that you can't "understand how any court can allow such things as doctors choosing NOT to do their job because they are morally against it." Well...who mentioned anything about the court system? There's nothing in Dr. B's blog entry about it, and there's no extended discussion in the linked article about a court-related issue. Venting your anger about something that doesn't even exist makes your point seem silly.
Finally, you write that you "have seen on other [sic] blog is what about Muslim women who become doctors... as they are not to be alone with or see the bodies of non-related men." This is truly irresponsible of you and I'm a little surprised Dr. B didn't include a caveat about it. If you're going to make a controversial assertion about anything, but especially Muslims in a discussion forum held in the US, then you should at least cite your source. Where was this "other blog," and who in that blog said that Muslim women could not care for men? Was it just someone shooting off at the mouth like you, or was it an acutal authority?
In the day and age of Google, it's really not that hard to verify information for yourself. Just type in "can Muslim women be doctors" and you'll get a lot of hits, including this one (http://www.youtube.com/watch?v=TUFlNNSS5Hc) that discusses not only the appropriateness of Muslim women serving as doctors, but allowing them to care for men. While there is probably a range of religious views on that subject and that extreme Wahabist doctrine either forbids or strongly discourages female Muslim physicians, it's clear that there is at least a variety of opinions on the matter. (I also note that one of my classmates from medical school in Cincinnati--not exactly a "Mecca" for Muslim students, pardon the pun--wore a hijab every day and as far as I know never once objected to any portion of the medical curriculum, which obviously involved caring for male patients.)
In short, Suze, it's not wise to write purely out of pique and you should really think about verifying and citing your arguments before your fingers start clacking on the keyboard.
Suze, I'm in general agreement with your thoughts, but you've said at least three things here that are at least artless and potentially highly misleading.
You note that "it is quite simple, but no one likes the ramifications (especially doctors)," where "it" means physicians checking their own personal moral values at the door. As a practicing physician who speaks with many colleagues about these kinds of issues on a daily basis, I'd beg to differ. In medical schools physicians are taught to treat patients without being morally judgmental, and the vast majority of the profession has taken these teachings to heart. I have never seen a physician, for instance, who has refused treatment to an IV drug addict with an infection at his or her shooting site simply because they regarded it as immoral, or for that matter because they knew that they'd most likely be treating that same addict weeks or months later. So your quip that we doctors especially have a problem doesn't ring true. Sorry.
You then say that you can't "understand how any court can allow such things as doctors choosing NOT to do their job because they are morally against it." Well...who mentioned anything about the court system? There's nothing in Dr. B's blog entry about it, and there's no extended discussion in the linked article about a court-related issue. Venting your anger about something that doesn't even exist makes your point seem silly.
Finally, you write that you "have seen on other [sic] blog is what about Muslim women who become doctors... as they are not to be alone with or see the bodies of non-related men." This is truly irresponsible of you and I'm a little surprised Dr. B didn't include a caveat about it. If you're going to make a controversial assertion about anything, but especially Muslims in a discussion forum held in the US, then you should at least cite your source. Where was this "other blog," and who in that blog said that Muslim women could not care for men? Was it just someone shooting off at the mouth like you, or was it an acutal authority?
Plus, in the day and age of Google, it's really not that hard to verify information for yourself. Just type in "can Muslim women be doctors" and you'll get a lot of hits, including this one (http://www.youtube.com/watch?v=TUFlNNSS5Hc) that discusses not only the appropriateness of Muslim women serving as doctors, but allowing them to care for men. While there is probably a range of religious views on that subject and that extreme Wahabist doctrine either forbids or strongly discourages female Muslim physicians, it's clear that there is at least a variety of opinions on the matter. (I also note that one of my classmates from medical school in Cincinnati--not exactly a "Mecca" for Muslim students, pardon the pun--wore a hijab every day and as far as I know never once objected to any portion of the medical curriculum, which obviously involved caring for male patients.)
In short, Suze, it's not wise to write purely out of pique and you should really think about verifying and citing your arguments before your fingers start clacking on the keyboard.
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