Essay: Human rights, personal responsibility, and the teaching of medicine

Abstract

It is hard for most of us to believe that physicians have assisted in the torture of political prisoners, that others have falsified medical reports and autopsy findings to conceal the mistreatment of prisoners, and that still others have assisted repressive regimes in suppressing political dissidents by confining them on psychiatric wards with fabricated diagnoses. These acts so violate the most elementary principles of medical care and are so far from what we believe we ourselves might ever do that we stand aghast, as we should. However, condemning abuses of human rights when they occur in other countries and in such blatant form is not sufficient. The challenge is to identify the ways in which a doctor’s moral faculty can atrophy so gradually that personal responsibility is abdicated altogether; that is, the challenge is to scrutinize our own behavior in the every day world of medicine to ensure that we do not become complicit in the banal ways that lead step by step to worse violations. From the time we enter medical school, each of us must accept the responsibility, not only to avoid moral error in our own work, but also to confront unethical behavior among our colleagues and in the institutions in which we serve. Many who will agree in principle still hesitate to urge students to confront the missteps of their teachers or their school lest they jeopardize their careers. Academic experience over some 40 years has taught me that the student who suppresses his or her dismay at the mistreatment of a patient in a first year clinic will no longer perceive the same act as constituting mistreatment by the third year of medical school and will perpetuate it himself or herself when he or she becomes a house officer. The house officer who accommodates to unethical behavior [“because no one will listen to me now. I can have more influence when I am on the senior staff and I’ll never make it if I speak up”] becomes the practitioner or the tenured professor who is still waiting for the right moment to act when he or she becomes emeritus. The Hippocratic Oath enjoins the physician to: