By Elizabeth Lanphier
In the United States, where I live and work, it is common for physicians to speak out on a variety of topics both before and during the COVID-19 pandemic. For example, physicians advocate against gun violence as a matter of public health. Pediatricians become #tweetiatrician on social media to raise awareness about children’s health, such as vaccine safety. Advocacy is embraced by professional medical associations and in some institutions is becoming part of promotion dossiers for clinicians.
I am enthusiastic about these advocacy efforts. But I have reservations about the arguments for physician outreach Rael Strous and Tami Karni offer in an article appearing in JME for why, during the COVID-19 pandemic, physicians have individual obligations, versus the medical community’s collective obligation, toward outreach.
My concern is not the claim that expertise should be shared. (It should!) Nor do I think there is any neat distinction between physician responsibilities for individual health and public health. But I worry that when Strous and Karni alternately frame physician duties to “speak out” as individual duties and collective ones, they collapse necessary distinctions between the risks, benefits, and demands of these two types of obligations.
Many of us have various role-based individual responsibilities. We can have obligations as a parent, as a citizen, or as a professional. Having an individual responsibility as a physician involves duties to your patients, but also general duties to care in the event you are in a situation in which your expertise is needed (the “is there a doctor on this flight?” scenario).
Collective responsibility, on the other hand, is when a group has a responsibility as a group. The philosophical literature debates hard to resolve questions about what it means to be a “group,” and how groups come to have or discharge responsibilities. Collective responsibility raises complicated questions like: If physicians have a collective responsibility to speak out during the COVID-19 pandemic, does every physician has such an obligation? Does any individual physician?
Because individual obligations attribute duties to specific persons responsible for carrying them out in ways collective duties tend not to, I why individual physician obligations are attractive. But this comes with risks. One risk is that a physician speaks out as an individual, appealing to the authority of their medical credentials, but not in alignment with their profession.
In my essay I describe a family physician inviting his extended family for a holiday meal during a peak period of SARS-CoV-2 transmission because he didn’t think COVID-19 was a “big deal.”
More infamously, Dr. Scott Atlas served as Donald J. Trump’s coronavirus advisor, and although he is a physician, he did not have experience in public health, infectious disease, or critical care medicine applicable to COVID-19. Atlas was a physician speaking as a physician, but he routinely promoted views starkly different than those of physicians with expertise relevant to the pandemic, and the guidance coming from scientific and medical communities.
Admittedly consensus during the pandemic is complicated by the novelty of an evolving virus about which science and medicine are continually learning. Yet medical associations and professional groups have coalesced around clear guidance on topics like the value of masking, or the safety and benefits of vaccination.
And still, anecdotes suggest at least some physicians depart from medical consensus, downplaying COVID-19 and expressing skepticism about pandemic precautions or vaccines. Some of these physicians could see it as their individual obligation to speak out and do outreach – including toward the insular communities less likely to seek out medical information that Strous and Karni take to be important targets of physician outreach.
A danger then when individual physicians speak for themselves as physicians but not with the medical community, is that they could be misconstrued as speaking both with and for a medical community. This comes with serious risks. It is dangerous for the targets of their advocacy. It also further compromises public trust in science.
This doesn’t mean physicians can’t speak out as individuals, nor does it imply consensus must precede advocacy. Speaking out can be an essential step in galvanizing consensus. Dr. Mona Hanna-Attisha held the press conference that spurred response to the lead poisoning water crisis in Flint, Michigan. Dr. Rochelle Walensky, the director of the US Centers for Disease Control and Prevention recently declaring racism a public health threat, coalescing and giving institutional backing to a collection of insights from scholarship and clinical practice.
But when physicians speak out about COVID-19, pandemic precautions, and now vaccination – as many are and should –there are good reasons to see this as part of a collective responsibility. It is a collective responsibility in which individual physicians share, rather than merely and individual duty.
Author: Elizabeth Lanphier
Affiliations: Assistant Professor, Ethics Center, Cincinnati Children’s Hospital Medical Center; Division of General and Community Pediatrics in the Department of Pediatrics, University of Cincinnati College of Medicine; Department of Philosophy, University of Cincinnati.
Social media: @EthicsElizabeth
Competing interests: None declared