Many philosophers, lawyers and writers illuminate. Others lecture
doctors about getting their hands dirty when they themselves would not
stoop to do the same. The medical ethics industry risks destroying the
moral ties that bind our profession in its enthusiasm to examine what
drives doctors to fulfil their duty of care (1). There are a host of
reasons why some health workers stay and others flee when that duty puts
them at personal risk. Some will be to do with inner motivation and
conscience, others to do with external rules, contracts, laws or encoded
GMC guidance (2). Shame, and the moral opprobrium of our colleagues and
society if we abandon patients, plays a part. Doctors regularly take
personal risks (whether of catching a contagious disease or receiving a
complaint), as part of the bond whereby we obtain, deserve and enact the
trust and high regard of the public (3). Those are the doctors we’d want
when we are patients. Vocation matters, and sometimes we will meet heroic
opportunities or dangerous threats. Doctors routinely face dilemmas and
conflicts between their duties. Moral competence and wise judgment don’t
come from wishful thinking or ticklists; we prepare, practice and simulate
until it becomes embedded.
There is little evidence that ethics teaching
itself delivers higher quality doctors or patient care (4,5). We are
trained, by each other, both in technical skills and moral fibre, just as
pilots are. Captain Chesley Sullenberger was highly technically skilled
and put his passengers first, at personal risk, when landing his plane in
the Hudson river. He could have pushed to the front. He could have died
when getting off the plane last after rechecking the cabin. But he didn’t.
Amazing? Or part of the territory? When bad snow events, or pandemic ‘flu
come, experts in emergencies take charge and individuals have to do their
best. Will you or I be “up to it” in the crisis? Maybe. Maybe not. We
will each live with the internal and external consequences and that sets
us apart. None of us knows how we will react until we are tested. Not
content with comparing doctors with magicians (6), Dan Sokol plays with
dangerous arguments that give succour to undermining professionalism:
whether we submit to employers or the GMC is not a matter of giving ‘valid
consent’ to fulfil our duty of care – it’s bound by law; there is no
precision in the estimates of risk - just judgements; and duties aren’t
optional or open for consultation – they’re duties we may fulfil or we may
fail. If a pandemic comes, undoubtedly there will be ethicists writing
about it afterwards. But, be careful, Dan, not to destroy what gives you
your living as you too might be vulnerable to ‘flu.
(1) Sokol DK. When can doctors stay away? BMJ 2009;338:270
(2) General Medical Council. Good Medical Practice. 2006
(3) Royal College of Physicians. Doctors in Society. Medical
professionalism in a changing world. Report of a Working Party. RCP,
London 2005
(4) Brewin TB. How much ethics is needed to make a good doctor? Lancet
1993:341:161-3
(5) Ethics in practice: background and recommendations for enhanced
support. A report of the working party on clinical ethics. RCP, London
2005
(6) Sokol D. Medicine as performance. What can magicians teach doctors? J
RoySoc Med. 2008:101:443-6
Competing interests:
I chaired the RCOG Ethics Committee 2004-6, which did not support the RCP recommendation for more clinical ethics in view of the lack of evidence of benefit.
Rapid Response:
Killing the goose that lays the golden eggs
Many philosophers, lawyers and writers illuminate. Others lecture
doctors about getting their hands dirty when they themselves would not
stoop to do the same. The medical ethics industry risks destroying the
moral ties that bind our profession in its enthusiasm to examine what
drives doctors to fulfil their duty of care (1). There are a host of
reasons why some health workers stay and others flee when that duty puts
them at personal risk. Some will be to do with inner motivation and
conscience, others to do with external rules, contracts, laws or encoded
GMC guidance (2). Shame, and the moral opprobrium of our colleagues and
society if we abandon patients, plays a part. Doctors regularly take
personal risks (whether of catching a contagious disease or receiving a
complaint), as part of the bond whereby we obtain, deserve and enact the
trust and high regard of the public (3). Those are the doctors we’d want
when we are patients. Vocation matters, and sometimes we will meet heroic
opportunities or dangerous threats. Doctors routinely face dilemmas and
conflicts between their duties. Moral competence and wise judgment don’t
come from wishful thinking or ticklists; we prepare, practice and simulate
until it becomes embedded.
There is little evidence that ethics teaching
itself delivers higher quality doctors or patient care (4,5). We are
trained, by each other, both in technical skills and moral fibre, just as
pilots are. Captain Chesley Sullenberger was highly technically skilled
and put his passengers first, at personal risk, when landing his plane in
the Hudson river. He could have pushed to the front. He could have died
when getting off the plane last after rechecking the cabin. But he didn’t.
Amazing? Or part of the territory? When bad snow events, or pandemic ‘flu
come, experts in emergencies take charge and individuals have to do their
best. Will you or I be “up to it” in the crisis? Maybe. Maybe not. We
will each live with the internal and external consequences and that sets
us apart. None of us knows how we will react until we are tested. Not
content with comparing doctors with magicians (6), Dan Sokol plays with
dangerous arguments that give succour to undermining professionalism:
whether we submit to employers or the GMC is not a matter of giving ‘valid
consent’ to fulfil our duty of care – it’s bound by law; there is no
precision in the estimates of risk - just judgements; and duties aren’t
optional or open for consultation – they’re duties we may fulfil or we may
fail. If a pandemic comes, undoubtedly there will be ethicists writing
about it afterwards. But, be careful, Dan, not to destroy what gives you
your living as you too might be vulnerable to ‘flu.
(1) Sokol DK. When can doctors stay away? BMJ 2009;338:270
(2) General Medical Council. Good Medical Practice. 2006
(3) Royal College of Physicians. Doctors in Society. Medical
professionalism in a changing world. Report of a Working Party. RCP,
London 2005
(4) Brewin TB. How much ethics is needed to make a good doctor? Lancet
1993:341:161-3
(5) Ethics in practice: background and recommendations for enhanced
support. A report of the working party on clinical ethics. RCP, London
2005
(6) Sokol D. Medicine as performance. What can magicians teach doctors? J
RoySoc Med. 2008:101:443-6
Competing interests:
I chaired the RCOG Ethics Committee 2004-6, which did not support the RCP recommendation for more clinical ethics in view of the lack of evidence of benefit.
Competing interests: No competing interests