Take Your Clothes Off, Oppressor
When Doctors Discard Sacred Oaths
If you’re not already a subscriber to Bastiat’s Window, please sign up for a free or paid subscription. (Paid really helps!) By all means, share the site and its articles with friends. This essay is adapted from three earlier pieces, all published by InsideSources: Life, Death and Intimacy in Medicine (5/9/18), Of Race and Health Care (3/8/22), and On the Sanctity of Medical Oaths (4/12/22).
Do you want someone who despises you, your opinions, or your ancestry to demand that you remove your clothing? Because as medical schools and other healthcare institutions see patients as members of demographic groupings rather than as individuals, that will be the end result.
Long ago, I developed a classroom exercise for my graduate students—most of whom were doctors, nurses, and allied health professionals. I asked whether anyone in the room had had serious surgery in the past few years. Invariably, some had. I would choose one and ask a battery of questions, to which they always had ready answers:
“Who performed the operation?” // “Dr. Smith.”
“Where did she study medicine?” // “Georgetown University.”
“How long had she been practicing?” // “10 or 15 years.”
“Was she highly regarded by peers and patients?” // “Yes. Great scores.”
“Why did you check all this information beforehand?” // “Because my life was in her hands.”
I then asked the same student a second series of questions:
“Have you flown on a commercial aircraft recently?” // “Sure.”
“Who was the pilot?” // <silence> “I don’t know.”
“Where did he learn to fly?” // “No idea.”
“How experienced was he?” // “Haven’t the faintest idea.”
“Did you check his credentials beforehand?” // “How would I?”
“Was your life any less in his hands than in the surgeon’s hands?” // “No.”
“Can you explain why you were more diligent with the surgeon than with the pilot?” // “(Shrug.)”
Asked to explain the differences between the surgeon and the pilot, the students—all medical professionals—struggled. Most of their explanations crumbled upon probing. Both scenarios involve complex, delicate, life-and-death procedures. Only once did I ever receive a truly unassailable answer as to the difference. A nurse said:
“Because the pilot never asks you to take your clothes off.”
Her answer was profound. Perhaps the real value in the doctor-patient relationship is, as she suggested, comfort in a deeply discomfiting situation.
Race is probably the hottest hot-button issue in America today. Concern with racial discrimination permeates education, employment, politics and ordinary discourse. For those whose work focuses on healthcare, racial issues have become an unavoidable presence.
In 2021, two physicians, Bram Wispelway and Michelle Morse, suggested race-based hospital admissions as part of an “antiracist agenda for medicine. Espousing a similar sentiment, Brookings Institution scholars Rashawn Ray and Alexandra Gibbons rejected the mid-20th-century’s central strategy for addressing inequality: a “colorblind ideology.” Citing critical race theory, they argued that healthcare and other American institutions “are laced with racism embedded in laws, regulations, rules and procedures that lead to differential outcomes by race.” Another Brookings scholar, Shadi Hamid, was disturbed by such proposals. He noted that hospitals in various states have instituted racial preferences in distributing scarce treatments for COVID-19. Hamid wrote, “The possibility that someone’s race could, quite literally, affect whether they qualify for lifesaving COVID treatment isn’t just another inconvenience. In theory as well as practice, it is a matter of life and death.”
In 2021, the American Medical Association and the Association of American Medical Colleges issued a 54-page speech code — Advancing Health Equity. This document is permeated by an assumption that all racial disparities in health are caused by racism as opposed to, say, genetics or individual behavior. The document focuses repeatedly on the impact of “whiteness” on healthcare in America and beseeches doctors to engage in heavily politicized and often accusatory speech.
As suggested by my student’s “take your clothes off” scenario, medicine requires a degree of trust unlike any other profession. Errors by airline pilots, bus drivers, engineers and car mechanics can kill as surely as errors by doctors. But medicine alone requires consumers (patients) to surrender their privacy and allow strangers access to their bodies.
This terrible intimacy underlies the world’s medical oaths. Across cultures, two themes emerge: Doctors must not purposefully harm patients, and doctors must see patients as individuals and not as avatars of ethnicities, religions, viewpoints or personal qualities. Doctors don’t always live up to such standards, which is why it is so important that the medical profession and society at large express collective displeasure with violators.
Under the Hippocratic Oath, doctors promise they “will do no harm or injustice” to patients and that they will “abstain from all intentional wrongdoing and harm, especially from abusing the bodies of man or woman, slave or free.”
The Jewish Oath of Maimonides says, “May I never see in the patient anything but a fellow creature in pain.” Another Jewish medical oath, the Oath of Asaf, instructs the doctor, “Do not keep in your hearts the vindictiveness of hatred with regard to a sick man.” The Oath of a Muslim Physician asks for assistance “that we may devote our lives in serving mankind, poor and rich, literate or illiterate, Muslim or non-Muslim, black or white with patience and tolerance.” By the Vejjavatapada, a Buddhist doctor promises to “use my skill to restore the health of all beings.”
Powerfully, Japan’s Seventeen Rules of Enjuin say that doctors should “always be kind to people” and “rescue even such patients as you dislike or hate.”
Doctors Without Borders treats people without regard to race, religion, creed or politics. In Israel, Hadassah Hospital and other facilities regularly treat and sometimes save the lives of terrorists wounded in attacks on Israelis. A colleague told me that in medical school, she was told starkly that she was to treat prison inmates as she would anyone else.
Patients must have confidence that the doctor in the clinic or the emergency room will not seek to harm them or treat them less effectively than they would someone of a different race, politics, history or demeanor.
The damage from breaches can last for generations. Over the course of the pandemic, some attributed vaccine hesitancy among African-Americans to distrust stemming from historical wrongs — including the horrid “Tuskegee Study of Untreated Syphilis in the Negro Male” and general bias among 20th-century physicians. The medical profession didn’t rein in such behavior and was sometimes an enthusiastic participant in what were clear violations of medical oaths.
In the hyperpoliticized America of today, new violations make headlines — and the question is whether these will be isolated incidents or parts of a trend.
At the Yale School of Medicine in 2021, a psychiatrist fantasized about murdering white people in her lecture, “The Psychopathic Problem of the White Mind.” Yale issued a tepid criticism, though some in attendance praised the speech. In 2022, a medical student at Wake Forest University perceived a patient’s attitude toward her “pronoun pin” to be bigoted; afterward, she expressed pleasure on Twitter at having missed his vein in a blood draw, forcing him to endure the pain of a second stick. To its credit, the medical school quickly condemned the student’s public attitude and put her on leave of absence. To the student’s credit, she issued a lengthy, unqualified apology for her actions.
Ethical breaches will happen, but real danger comes in normalizing such actions. An editorial in the Wake Forest campus newspaper called criticism of the student “excessive” and said:
“The crux of the issue at hand is not the conduct of (the medical student), but the bigotry expressed by her patient.”
That editorialist couldn’t have been more mistaken. Patients are human, and a substantial number possess unsavory characteristics. Those characteristics must have absolutely no relevance to the doctor’s attitude or standard of care. Excusing such ethical breaches encourages others to spurn the high principles embodied in those great medical oaths.
In Ernest Hemingway’s “The Sun Also Rises,” one character explains how he went bankrupt: “Two ways. Gradually, then suddenly.” Trust can vanish in the same ways that money can.
Lagniappe
A few weeks back, Lagniappe offered a video of Tom Lehrer singing his 1965 song “Pollution.” At the risk of using the same source a second time, here’s Lehrer singing “National Brotherhood Week,” from the same album. In 2020 and 2022, Mr. Lehrer kindly placed all of his works in the public domain.
Martin Makary, a professor of surgery at Johns Hopkins, estimated the number of deaths from medical errors at 250,000 annually in the USA. From 2000 to 2021, not counting the terrorism of 9/11, there were 19 deaths in commercial aviation. Since your doctor is vastly more likely to kill you than your airline pilot and since you have some choice about doctors but merely Hobson's choice about airline pilots, it makes sense to be much more selective about your doctor than your airline pilot.
What's the difference between matter and antimatter?
If you ask a physicist, they'll tell you that a particle and its antiparticle are exactly identical in every way, except for a few specific properties, where they're exactly identical in every way except for being oriented in the opposite direction. And if they ever come together, a violent explosion occurs.
This is the best paradigm I've found for understanding "anti-racism" and "anti-fascism."