Doctor and Other Health Professionals

I teach bioethics to medical students. One of the lecture topics we cover in our class is the relationship of doctors with other health care professionals. In our current medical practice, paternalism is no longer the prevailing practice. We recognize the role of other health care providers in the well-being of the patient.

If you are interested to know more on this topic, you are welcome to join us. Below is the link for the handout on the lecture on Doctors and Other Health Professionals.

Download the E-book here.

Ethics of Privacy and Respect for Other People's Property

I always teach my kids to ask permission before they touch other people's stuff. That is a basic value people learn early in life. So, one wonders if it is morally right for the BOC employees to check the stuff sent by nurses and doctors to their families and friends? 

Can I open this?

The Philippines is one of the top exporter of nurses and doctors around the world next to India based on the IBON data for 2014. The healthcare workers form the largest chunk of OFWs. They work abroad to provide for their families, families that they do not see often. Despite being physically away, these OFWs show their love and care to their family members with the gifts of love they send to them through balik-bayan boxes. As one popular courier tagline puts it "Ipadama mo sayong padala." Every balikbayan box sent is an expression of love from a lonely OFW healthcare worker.

The "expression of love" is ripped open by the Bureau of Customs employees before it even reaches the supposed recipient. Did the people in the Bureau of Customs ask permission from the OFW healthcare worker? Is it morally right to open other people's packages without their consent? Is it ethical to sort other people's property? Is it valid to rip open a "package of love" for suspecting something taxable inside? What happened to people's privacy? What happened to autonomy? What happened to respecting people's right?

Privacy is an ethical issue. Is it morally right to invade my privacy? Privacy is important for several reasons. Privacy is necessary to safeguard the freedom of individuals and groups. People have the right to keep private and personal matters from the public. If people have the right to privacy, it is morally wrong to violate that right. It is unethical to invade other's privacy and personal property. For the same reason, invasion of privacy is against the law. For example, when I go to the mall and the security guard wants to inspect my bag, the guard cannot just open my bag. That would be unethical. The guard would be violating my privacy. That is why, I would have to willingly open the zipper of my bag and allow the guard to take a peek and inspect what is inside. Only because I allowed the guard to check my bag was the guard able to do it. No invasion of privacy occurred.

The government is supposed to safeguard the people's right to privacy, not the one violating it.

However, we also know that privacy is not an absolute thing. We live in a society that requires us to share information to maintain order in our relationship with each other. Going back to our example, I cannot just refuse the guard to check my bag because of my right to privacy. If I do that, the guard can always refuse my entry into the mall. In the same way, the balik-bayan boxes need to have proper declaration from the OFWs sending them. It is the OFWs duty to honestly declare the contents of the package. We understand that the government needs some information from its citizen for it to be able to govern properly and execute their responsibilities well.

There should be a balance between the OFW's responsibility to share honest information and to the protection of it's right to privacy. One is not more important than the other. The government cannot also give lesser weight to either of the two. It would not only be unethical for the government staff to open packages without the owner's consent, the government would also be violating the people's human rights.

Let this not be another addition to the long list of human rights violation of the government to its people. How can I teach my kids to respect other people if they do not see their government respecting people too?

Is the Hippocratic Oath still Relevant in our practice?

The Hippocratic Oath is one of the oldest known formulations of medical ethics. Throughout history, the practice of medicine has been guided by a code of ethics and the widely used basis for this is the Hippocratic Oath. The oath is a declaration to practice the profession of medicine justly and ethically. Medical students often recite the Oath as rite of passage as they become new doctors. However, many has criticized that the Oath has become ceremonial and non-obligatory for many. There are many changes now and advances in the practice of medicine. Some doctors argue that the Oath is outdated. Take a review of the Oath:

The Hippocratic Oath in Cross Format

HIPPOCRATIC OATH

I SWEAR by Apollo physician and Asclepius and Hygeia and Panacea, all the gods and goddesses, making them witness, that I will fulfil according to my ability and judgment this oath and this covenant.

To hold him who has taught me this art as equal to my parents and to live my life in partnership with him and if he is in need of money to give him a share of mine, and to regard his offspring as equal to my brothers in male lineage and to teach them his art --- if they desire to learn it --- without fee and covenant;

to give a share of precepts and oral instruction and all the other learning to my sons and to the sons of him who has instructed me and to pupils who have signed the covenant and have taken an oath according to the medical law, but to no one else.

I will apply dietetic measures for the benefit of the sick according to my ability and judgment; I will keep them from harm and injustice.

I will neither give a deadly drug to anybody if asked for it, nor will I make a suggestion to this effect. Similarly, I will not give a woman an abortive remedy. In purity and holiness I will guard my life and art.

I will not use the knife, not even on sufferers from stone, but I will withdraw in favor of such men as are engaged in this work.

Whatever house I may visit, I will come for the benefit of the sick, remaining free of all intentional injustice, of all mischief and in particular of sexual relations with both female and male persons, be they free or slaves

If I fulfill his oath and do not  violate it, may it be granted to me to enjoy life and art, being honored with fame among all men for all time to come; if I transgress it and swear falsely, may the opposite be my lot.

 

This oath set a very high standard of professional conduct which had become the moving spirit and ideal for those who practice the noble profession of healing since time immemorial. But note the principles on euthanasia, abortion, confidentiality, doctor-patient relationship. You look at the profession now and it seems different from what the Oath promotes. Do you think the Oath is it still relevant in our practice? Or have we deviated from the ideals of the practice of medicine?