The ethical responsibility of the physicians: a judeo-christian perspective.

While a resident in psychiatry at a large metropolitan hospital, I was called to the Emergency floor one evening to see a Hispanic lady, who was reported to have an anxiety attack. I found the lady very distraught, frightened, and shaking all over. Since she could not understand English, I asked her in Spanish what was wrong. She told me she had been feeling upset after a quarrel with her daughter-in-law and had come to the hospital to talk with someone. However, when she arrived at the hospital, the doctor, unable to communicate with her, assumed she had taken an overdose of drugs. He forced a rubber tube down her throat and pumped out her stomach. In desperation, she told me: "I feel worse now than before I came to the hospital." This is an example of how traditional health care delivery has been a one-way process, from health care provider (physician) to consumer (patient). This has been so for planning, treatment, and research. In many ways, the consumer has had no choice but to shut his mouth and be thankful for the crumbs of blessing, good or bad, falling from the table of the all-powerful health care provider. This situation has-led to blatant abuses of the doctor-patient relationship: the unethical Tuskegee syphilitic study, experiments with the injection of potentially lethal hepatitis virus into mentally retarded residents at Willowbrook, and deplorable care of the elderly and other underprivileged groups, to name but a few (1). The underlying dynamic here is that of power (provider) versus powerlessness (consumer). Thus, in such a situation, the quality of health care is directly proportional to one's power base, e.g., intelligence, financial status, race, political support, awareness of system, etc. However, health care delivery, like any other psychologically sound interpersonal relationship, must be a two-way process with the provider and consumer working together in a constructive and trusting relationship. But this psychological awareness is not enough. The two-way relationship must be buttressed with a mature ethical or moral framework which engenders respect for the human rights and personhood of the provider and the consumer. According to Ivan Illich (2), "Medicine is a moral enterprise and, therefore, inevitably gives content to good and evil: In every society, medicine like law and religion, defines what is normal, proper and desirable. Medicine has authority to label one man's complaint a legitimate illness, to declare a second man sick-though he himself does not complain-and to refuse a third social recognition of his pain, his disability and even his death!"