An Old Doctor Reading Harrison’s Principles of Internal Medicine for the Last time
Ethical Issues in Clinical Medicine Chapter 8
In 1973 medical ethics did not take up a chapter. Little was said about the subject. Dr. Howard Brody was one of the first to bring this to the forefront in the late 1970’s.
Chapter 8 speaks of virtue ethics which focuses on physicians’ character and qualities with the expectation that doctors will cultivate such virtues as compassion, trustworthiness, intellectual honesty, humility, and integrity.
Absent these virtues the doctor-patient relationship is jeopardized
Ethics are slipping form the hands of the individual physician and into the hands of the corporate. Physician autonomy, patient equity and increasing costs are predicted.
Recently in NEJM (Jan 12 2023) in perspective it sites, “Corporate Investment in Primary Care-Profits, Progress, and Pitfalls.” The major players are not physicians or medical schools but Amazon, CVS, Walmart, Humana, Algion Health. Treatment protocols will be corporatized. Ethics may as well.
My concern is complicity. It will be “go along to get along.”
When I think of complicity, I recall my reading of Joseph Conrad’s Lord Jim. Published in 1899 it has influenced my professional life. Jim is a young British seaman with a bright future. He finds himself on the Patna a ship carrying 800 Muslims on their religious journey to Mecca, the hajj. The ship takes on water and Jim joins the crew to the lifeboats abandoning the ship and the pilgrims. Jim and the crew are rescued. A French navy ship rescues the pilgrims as well and Jim and the crew are tried in a maritime court, vilified and lose their certificates to sail.
Jim is ruined. His life is now one of redemption.
Jim is obsessed to redeem himself and expunge his cowardice. This leads to a fatal conclusion. On the island of Padua.
In the final scene of the novel, Jim redeems himself the hard way:
He passes away under a cloud inscrutable at heart, forgotten, unforgiven and excessively romantic. Not in the wildest days of his boyish visions could he have seen the alluring shape of such an extraordinary success!…He goes away from a living woman to celebrate his pitiless wedding with a shadowy ideal of conduct. Is he satisfied-quite now, I wonder? We ought to know. He is one of us-
I wonder would Lord Jim feel the same had he not been discovered and the pilgrims drowned?
It seems people are remorseful only if they get caught.
I’ve always tried to avoid Jim’s mistake and not be complicit.
Complicity can save your career but ruin your life and who you are or think you are.
During Covid we had a chance to abandon ship but most of we healthcare workers stood fast.
Albert Camus wrote, “What’s true of all the evils in the world is true of plague as well. It helps men to rise above themselves.”
As I re-read Harrison’s for the last time, I have come to appreciate how much literature has helped me navigate a medical career.
Next Chapter: Hospice