Medicine requires a degree of confidence unlike any other profession. The mistakes of airline pilots, bus drivers, engineers and auto mechanics can kill as surely as the mistakes of doctors. But medicine alone requires consumers (patients) to give up their privacy and allow strangers access to their bodies.
This terrible intimacy underlies the medical oaths of the world. Across cultures, two themes emerge: physicians should not deliberately harm patients, and physicians should view patients as individuals and not as avatars of ethnicity, religion, viewpoint, or personal quality. Doctors don’t always meet these standards, which is why it’s so important that the medical profession and society as a whole voice their collective dissatisfaction with violators.
Under the Hippocratic oath, doctors promise that they will ‘do no harm or injustice’ to patients and that they ‘will refrain from intentional wrongdoing and harm, especially abuse of the body of the patient. ‘a man or a woman, (slave) or free’.
The Jewish oath of Maimonides says, “May I never see in the patient anything but a fellow in pain.” Another Jewish medical oath, the Oath of Asaf, commands the doctor: “Do not keep in your heart the vindictive character of hatred towards a sick person. A Muslim doctor’s oath asks for help “so that we may dedicate our lives to the service of humanity, poor and rich, literate or illiterate, Muslim or non-Muslim, black or white, with patience and tolerance.” Through the Vejjavatapada, a Buddhist doctor promises “to use my skills to restore the health of all beings”.
Powerfully, Enjuin’s Seventeen Rules of Japan say doctors should “always be kind to people” and “save even patients you don’t like or hate.”
Doctors Without Borders treats people regardless of race, religion, creed or politics. In Israel, Hadassah Hospital and other facilities routinely treat and sometimes save the lives of terrorists injured in attacks on Israelis. A colleague recently told me that in medical school she was told in no uncertain terms that she should treat inmates like anyone else.
Patients need to trust that the physician in the clinic or emergency room will not seek to harm them or treat them less effectively than they would someone of one race, different politics, history or behavior.
Damage from breaches can last for generations. During the pandemic, some have attributed vaccine hesitancy among African Americans to mistrust stemming from historical wrongs – including the horrific “Tuskegee study of untreated syphilis in black males” and the general prejudice of 20th century physicians. The medical profession did not curb such behavior and at times participated enthusiastically in what constituted clear violations of medical oaths.
In the hyperpoliticized America of 2022, new violations are making headlines — and the question is whether these will be isolated incidents or part of a trend.
At Yale School of Medicine in 2021, a psychiatrist fantasized about killing white people in her lecture, “The Psychopathic Problem of the White Mind.” Yale issued a lukewarm review, although some in attendance praised the speech. In 2022, a medical student at Wake Forest University perceived a patient’s attitude toward her “pin pronoun” as bigoted; afterwards, she tweeted her joy at missing his vein during a blood draw, forcing him to endure the pain of a second stick. To its credit, the medical school quickly condemned the student’s public attitude and put her on leave. To the student’s credit, she issued a lengthy, unqualified apology for her actions.
Ethical breaches will occur. But the real danger comes from the normalization of such actions. An editorial in the Wake Forest campus newspaper called the student’s criticism ‘excessive’ and said: ‘The crux of the matter is not (the medical student‘s) conduct, but the fanaticism expressed by his patient.
This columnist couldn’t be more wrong. The patients are human and a substantial number possess unsavory characteristics. These characteristics should bear no relation to the physician’s attitude or standard of care. Excusing such lapses in ethics encourages others to reject the lofty principles embodied in these great medical oaths.
In “The Sun Also Rises” by Ernest Hemingway, a character explains how he went bankrupt: “Two ways. Little by little, then all of a sudden. Confidence can disappear the same way as money.
Robert Graboyes is a Principal Investigator at the Mercatus Center at George Mason University, where he focuses on technological innovation in healthcare. He is the author of “Fortress and Frontier in American Health Care” and has taught health economics at five universities. He wrote this for InsideSources.com.