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Monday, July 26, 2021

Do doctors engaging in advocacy speak for themselves or their profession?

Elizabeth Lanphier
Journal of Medical Ethics Blog
Originally posted 17 June 21

Here is an excerpt:

My concern is not the claim that expertise should be shared. (It should!) Nor do I think there is any neat distinction between physician responsibilities for individual health and public health. But I worry that when Strous and Karni alternately frame physician duties to “speak out” as individual duties and collective ones, they collapse necessary distinctions between the risks, benefits, and demands of these two types of obligations.

Many of us have various role-based individual responsibilities. We can have obligations as a parent, as a citizen, or as a professional. Having an individual responsibility as a physician involves duties to your patients, but also general duties to care in the event you are in a situation in which your expertise is needed (the “is there a doctor on this flight?” scenario).

Collective responsibility, on the other hand, is when a group has a responsibility as a group. The philosophical literature debates hard to resolve questions about what it means to be a “group,” and how groups come to have or discharge responsibilities. Collective responsibility raises complicated questions like: If physicians have a collective responsibility to speak out during the COVID-19 pandemic, does every physician has such an obligation? Does any individual physician?

Because individual obligations attribute duties to specific persons responsible for carrying them out in ways collective duties tend not to, I why individual physician obligations are attractive. But this comes with risks. One risk is that a physician speaks out as an individual, appealing to the authority of their medical credentials, but not in alignment with their profession.

In my essay I describe a family physician inviting his extended family for a holiday meal during a peak period of SARS-CoV-2 transmission because he didn’t think COVID-19 was a “big deal.”

More infamously, Dr. Scott Atlas served as Donald J. Trump’s coronavirus advisor, and although he is a physician, he did not have experience in public health, infectious disease, or critical care medicine applicable to COVID-19. Atlas was a physician speaking as a physician, but he routinely promoted views starkly different than those of physicians with expertise relevant to the pandemic, and the guidance coming from scientific and medical communities.