When the community is in need, physicians must honor call to duty
Dr. Cereste is a hospitalist and assistant professor of public health in the division of medical ethics at Weill Cornell Medical School and Medical Center in New York City. She is a member of TeamHospitalist.
As the American Medical Association (AMA) states in its inaugural Code of Ethics from 1847: “When pestilence prevails, it is their duty to face the danger and to continue their labors for the alleviation of the suffering, even at the jeopardy of their own lives.”1 It meant doctors have taken on a calling and social duty to treat sick patients, even at personal expense.
Today, the AMA’s Code of Ethics puts it this way: “Physicians should balance immediate benefits to individual patients with ability to care for patients in future.”2 Over two centuries, the focus remains on the physician’s duty to patient and society.
As a former Air Force physician, I believe in this deontological stance. In the Air Force, we often spoke of our sense of duty, of “service before self, and integrity in everything we do.” This code of conduct applies to combat as well as the peacetime challenges of pandemic flu. If the medical corps’ mantra is to “preserve the fighting force,” the mission of the civilian physician is the community’s survival. This implicit contract with society extends from moments of tranquillity to when the peace is disrupted by either manmade disasters (e.g., war) or biological threats (e.g., pandemic disease).
Having made this assertion, a physician’s obligation is not without its limitations. Doctors have a responsibility to protect themselves and their families from undue harm. We have to stay alive for utilitarian reasons in order to serve others. A society without its physician workforce is imperiled and at enhanced risk, so a physician’s self-preservation is also in the interest of the collective.3
All of this compels doctors to stay alive and remain healthy. Our duty can only be achieved by careful action and avoiding forays into Hollywood heroism. No one asked us to be heroes, only dutiful physicians.4
We have to prepare doctors to meet this challenge. Alexander and Wynia surveyed senior physicians: While 80% were willing to treat high-risk patients, as in bioterrorism or a pandemic, only 21% felt logistically prepared to meet such a challenge in practice.5
If we expect physicians to answer the call, we need to equip them with the knowledge, skills, and equipment necessary to safely and effectively meet their professional responsibilities.
That responsibility is one that society owes its physicians. TH
- Code of Medical Ethics of the American Medical Association. American Medical Association Web site. Available at: www.ama-assn.org. Accessed Nov. 30, 2009.
- American Medical Association. Physician Obligation in Disaster Preparedness and Response. Chicago: American Medical Association; 2004.
- Simonds AK, Sokol DK. Lives on the line? Ethics and practicalities of duty of care in pandemics and disasters. Eur Respir J. 2009;34(2):303-309.
- Sokol D. Virulent epidemics and scope of healthcare workers’ duty of care. Emerg Infect Dis. 2006;12(8):1238-1241.
- Alexander GC, Wynia MK. Ready and willing? Physicians’ sense of preparedness for bioterrorism. Health Aff (Millwood). 2003;22(5):189-197.
Some healthcare providers should be considered exceptions to rule
Dr. Egan is a hospitalist at the University of Colorado Denver and a member of SHM’s Ethics Committee.
Infectious illnesses frequently affect healthcare providers disproportionately. Whether physicians are obligated to put themselves at risk is not clear. Many sources argue that participation in infectious epidemic or pandemic events is obligatory, but there is another side to the discussion. Healthcare providers might have risk factors that mitigate this obligation. Two such subgroups are providers with pre-existing health concerns and providers who are caregivers for others.