Letters to the Editor
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As a clinical ethicist and philosopher who has written and lectured on professional duty during crises, I was particularly drawn to the viewpoint by James Chenoweth, MD. (“What is a Doctor's Duty in a Pandemic?” EMN. 2020;42:3; https://bit.ly/2U0RDaa.)
He made several salient points and highlighted the conflict between normative and descriptive ethics, which describe what one ought to do v. what one actually does, respectively. This reality often places undue conflict and a feeling of betrayal on the physician, who may feel that his actions, although self-justified, still fall short of society's expectations. This is a common cause of moral injury in today's pandemic era.
What distinguishes physicians from nonprofessionals is our specialized education and knowledge, and we must be organized into a collective body that self-regulates and enforces rules of conduct, have a duty to serve the public, and hold the interests of the patient in greater regard than the interests of the professional.
As a result and as part of our training, we physicians are expected to take on some risk. During the AIDS crisis of the 1980s and the resultant hysteria by the medical profession in dealing with the then novel and highly contagious yet not fully understood disease, philosophers spoke extensively on the societal expectations of the medical profession. To paraphrase, physicians have taken an oath, which demonstrates the gravity of their calling, and the nature of illness, the unique character of medical knowledge, and the oath of fidelity to patients' interest all generate strong moral obligations to care for patients despite some or even significant risk to the physician.
This is a virtuous stance, one many modern physicians may question or not readily relate to. These virtues partly distinguish physicians from nonphysicians, and renowned ethicists identify trustworthiness, integrity, discernment, compassion, and conscientiousness as key traits of all physicians.
Informed consent is not individually signed by physicians daily, but our medical licensing and board certifications contain language that reinforces the vow most physicians take in medical school to uphold the values and ethics of the profession, including our duty to treat. We are all well aware of our legal obligations to provide a medical screening exam under EMTALA.
Dr. Chenoweth is correct that an undue risk to individual physicians may require risk mitigation and other legal protections (OSHA, for example), with the onus at the institutional or governmental level. I echo his sentiment on the valor and bravery of our profession. In the face of illness and even death, we collectively faced down the challenges for our patients. Graeme Wood can extinguish his fires because physicians, in my opinion, need to be burned at the stake and lose their licenses as a result of inaction.
Al O. Giwa, MD, MBA
New York City