SARS and the Duty to Treat: Remember AIDS?

Abstract

To the Editor: Cast into gloomy contemplation of the fact that life-extension research is likely to offer too little, too late for me (Biogerontology, 'Anti-aging Medicine,' and the Challenges of Human Enhancement; Is More Life Always Better? HCR, JulyAugust 2003), I was briefly heartened when I read Chalmers C. Clark's short essay on health professionals' duty to care for victims of SARS (In Harm's Way: Service in the Face of SARS, HCR, July-August 2003). Advancing age, if not senescence, does have its uses, I thought, as I recalled an article published in these pages by John Arras at the height of the controversy over whether it was ethical for physicians to refuse to care for patients with HIV (The Fragile Web of Responsibility: AIDS and the Duty to Treat, HCR, April-May 1988). Clark argues that they do have such a duty, which they owe in exchange for all the privileges of prestige and income that society bestows on them. As Arras pointed out, this contractual obligation can be discharged by the profession as a whole, just so long as patients are being competently cared for by somebody. It can't yield a duty equally incumbent on every practitioner. Such an irreducibly individual obligation could only come from a conception of what it means to be a minimally virtuous physician. The argument for such a virtue, however, requires a very different vocabulary than contract theory. Deja vu all over again is probably only to be expected. Each generation of professionals, citizens, and bioethicists must struggle with recurring questions and make up its own mind. But now I feel even gloomier than before. How could each dawn be a brand-new day for a 150-year-old bioethicist? Tom Tomlinson Michigan State University Chalmers C. Clark replies: Tom Tomlinson wonders how my contract talk about professional duties, groupwise, is supposed to translate into an rgument for individuals becoming minimally vir uous doctors. The answer, I believe, depends on exposing exactly what is at stake in the contract (detailed in C. Clark, Trust in Medicine, Journal of Medicine and Philosophy 27, No. 1, (2002): 11-29). The medical contract I articulate crucially involves n exchange of trust in service from the medical p ofession-in the face of illness and disease, such as SARS-in return for professional autonomy and privilege granted by the public. The move to stimulating individual virtue comes from appreciating what is involved in maintaining trust relationships. Trust, when it works, is a personal boon and an economic or social lu-