William Cayley: Is the Good Samaritan the wrong metaphor to use for doctors?

bill_cayley_2A story from the Christian New Testament has provided the literary namesake for countless medical facilities, as well as legal and ethical principles guiding care for those in need, but it may be the wrong illustration—or at least, not an adequate one.

The “Good Samaritan” story is told in the book of Luke to answer the question “who is my neighbor?” After a traveler is beaten, robbed, and left for dead, he is helped and cared for not by either of the two religious professionals who pass him by, rather he is given aid by a stranger from a socially suspect group of outsiders. The point of the story is that “neighborliness” has to do with actions (caring, compassion), not simply with social proximity, respectability, or status. The challenging implication is that such “neighborliness” is an inherent part of our responsibility to each other, simply by virtue of being human.

Recently, however, while preparing a talk for our residents on responding in “Good Samaritan” situations to calls for medical assistance, I was prompted by some writings by Dr Ed Pellegrino to re-think the adequacy of the “Good Samaritan” for addressing the role of the physician in rendering assistance. While “neighborliness” would imply a common human responsibility to those in need, Dr Pellgrino argues that helping the person in need is a fundamental commitment or obligation inherent in being a physician—an obligation assumed on taking a professional oath (typically, some version of the Hippocratic Oath) when entering the profession of medicine. For example:

“At this moment, one enters a moral community whose defining purpose is to respond to and to advance the welfare of patients—those who are ill, who are in need of help, healing, or relief of suffering, pain, or disability.”

“Without the Oath the doctor is a skilled technician or laborer whose knowledge fits him for an occupation but not a profession.”

A similar sentiment is found in the World Medical Association (WMA) International Code of Medical Ethics:
“A physician shall give emergency care as a humanitarian duty unless he/she is assured that others are willing and able to give such care.”

Periodically in the medical literature, one finds articles addressing the practical or legal considerations inherent in responding to a call for medical assistance. Typically, these address the problem from the perspective of “should I respond?” or “should I be a Good Samaritan.”

I am beginning to think that this is the wrong perspective. Challenging as it is, the story of the Good Samaritan refers to a common human responsibility we each have to those who are our neighbors, whether we realize it or not. However, at least Dr Pellegrino and the WMA would both argue that for those who have committed to the medical profession, a commitment to respond has already been made a priori.

All ethical humans face the challenge of whether or not we will emulate the model of the “Good Samaritan” and help neighbors in need (whether they be crowds of refugees or a homeless person on a park bench). For a physician, however, when the call comes “Is there a doctor in the house,” the question should not be “Should I respond?” but rather “How can I help?”

End note: For those interested, the resources I’ve found most helpful in preparing my educational session are:

William E Cayley Jr practices at the Augusta Family Medicine Clinic; teaches at the Eau Claire Family Medicine Residency; and is a professor at the University of Wisconsin, Department of Family Medicine.

Competing interests: I declare that I have read and understood BMJ policy on declaration of interests and I have no relevant interests to declare.