The Ethical Healthcare Professional
February 8, 2024
by Robert E. Cranston, MD, MA (Ethics)
No one would choose to be treated by an unethical healthcare professional. So, how do we as established healthcare professionals go about teaching the next generation of caregivers how to behave ethically, and what are some of the most important areas we should focus on in education?
Hammurabi, and later the Pythagoreans—more commonly known as the Hippocratic group—established criteria they employed to help guide their physicians and physicians-in-training in professional patient care.
Key elements of the Hippocratic Oath included a covenantal relationship with “the gods and goddesses,” commitment to educating others, respect for teacher/physicians, respect for limitations of one’s own expertise, confidentiality and abstention from abortion, euthanasia and inappropriate sexual activities. The document further referred to purity and holiness of the physician and discussed having the trainee swear obedience to the “physician’s law” and none other, with the final distinctive that if the physician failed to live up to these moral standards, they pledged that they hoped that dishonor would taint their “life and art among all men for all time.”
Over the millennia, several other oaths containing similar ideas have been devised, but notably since the middle of the 20th century these generally have not included a concept of deity covenant, and they have become less and less specific as to the things a healthcare professional could or would do. Vague phrases, such as “respect for human life” have become commonplace. While popular TV or movie productions sometimes presuppose that healthcare professionals must swear to uphold the Hippocratic Oath, essentially no school or society employs this oath, and there is no such thing as a universal physician’s law requirement. There are, of course, ever-changing legal rulings, but these are reflective of society’s general sentiments, and notoriously fickle, whereas the original Hippocratic Oath was strongly countercultural, standing against observed societal wrongs.
In 1985, a landmark article, “known as the DeCamp Report, argued that basic instruction in medical ethics should be a requirement in all U.S. medical schools.” This soon became a Liaison Committee on Medical Education (LCME) requirement, remaining in effect since. Thus, all medical schools are accredited based on the presence of some form of ethics education.
The American Medical Association (AMA) recently posted its updated version of important ethics issues for medical students. Their top 10 list of important topics:
- Maintaining health and wellness as a physician.
- Using social media professionally.
- Reporting incompetent or unethical behaviors by colleagues.
- Involving medical students in patient care.
- Accepting gifts from patients.
- Working with surrogate decision-makers.
- Addressing inequities in healthcare.
- Managing conflicts of interest.
- Navigating genetics and reproductive medicine.
- Making decisions when professional, personal values diverge.
The site references the Romanell Report, which gives many more specifics, including one section where the student or resident should “…with an appropriate level of proficiency, manage ethical challenges in a professional manner in the following areas:” (a long list follows, which includes numerous things including religion and spirituality).
While the top 10 emphases are important, the AMA site and the Romanell Report, in the spirit of relativism, do not give specific guidance as to many things, and they also refrain from substantive instruction on abortion, assisted suicide, sexual orientation and gender identity, and trans-sexual endocrinological or surgical interventions. They given a token nod to conscience freedoms, but they leave it open enough that there is little protection for true conscience convictions.
The newest wrinkle in approaching medical ethics is artificial intelligence (AI). While at first glance this tool offers a greater degree of objectivity and consistency across time and space, the devil is in the details. Who will program the AI algorithms, and what standards will they use? If they use the prevailing guidelines—as vague and non-prescriptive as they are—we cannot expect reasonable, ethical decisions. Borrowing a phrase from the software development world, “Garbage in, garbage out.” More to the point, if the programs assume a worldview without God and without moral absolutes, we won’t get moral results.
If your aim is to practice medicine ethically or instruct trainees and colleagues to do so, where do you start? Providentially, CMDA has compiled thoughtful, ethical guidance on a number of issues, and these resources are available at no charge for your use. The Standards4Life section succinctly addresses eight issues including abortion, cloning, human genome research, faith and health, infertility and reproductive technology, assisted suicide, rights of conscience and stem cell research. Freedom2Care keeps one abreast of current state and federal policies and laws. The Point blog (which you are now reading) covers a variety of topics and provides new posts monthly for your review.
The CMDA Ethics Committee performs ongoing reviews and updates on a number of issues. At one point in time, the CMDA membership was limited to physicians and dentists, and some of these policies were last reviewed prior to the inclusion of a wider group of healthcare professionals. As revisions are ongoing, titles and more inclusive terminology will be edited, but the principles remain unchanged. A full list of CMDA’s Position Statements is available at www.cmda.org/ethics. Statements entitled “Principles of Christian Excellence in Dental and Medical Practice,” “Christian Physician’s Oath,” “Christian Dentist’s Oath,” “Biblical Model for Medical Ethics” and “Sharing Faith in Practice” are particularly helpful.
We are to be in the world, but not of the world. As we participate in caring for our patients, we must remain vigilant that the wider healthcare world does not pollute and dilute our service to God and others. The guidance of the documents highlighted above will help us do this.