{"id":4157,"date":"2021-06-17T21:44:07","date_gmt":"2021-06-17T20:44:07","guid":{"rendered":"https:\/\/blogs.bmj.com\/medical-ethics\/?p=4157"},"modified":"2021-06-17T23:11:55","modified_gmt":"2021-06-17T22:11:55","slug":"do-doctors-engaging-in-advocacy-speak-for-themselves-or-their-profession","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/medical-ethics\/2021\/06\/17\/do-doctors-engaging-in-advocacy-speak-for-themselves-or-their-profession\/","title":{"rendered":"Do doctors engaging in advocacy speak for themselves or their profession?"},"content":{"rendered":"

By Elizabeth Lanphier<\/p>\n

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<\/a>. Pediatricians become #tweetiatrician on social media to raise awareness about children\u2019s health, such as vaccine safety. Advocacy is embraced by professional medical associations<\/a> and in some institutions is becoming part of promotion dossiers<\/a> for clinicians.<\/p>\n

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 <\/em>for why, during the COVID-19 pandemic, physicians have individual <\/em>obligations, versus the medical community\u2019s collective<\/em> obligation, toward outreach.<\/p>\n

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 \u201cspeak out\u201d as individual<\/em> duties and collective<\/em> ones, they collapse necessary distinctions between the risks, benefits, and demands of these two types of obligations.<\/p>\n

Many of us have various role-based individual<\/em> responsibilities. We can have obligations as <\/em>a parent, as <\/em>a citizen, or as <\/em>a professional. Having an individual responsibility as a physician<\/em> 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 \u201cis there a doctor on this flight?\u201d scenario).<\/p>\n

Collective<\/em> responsibility, on the other hand, is when a group has a responsibility as a group<\/em>. The philosophical literature debates hard to resolve questions about what it means to be a \u201cgroup,\u201d and how groups come to have or discharge responsibilities. Collective responsibility raises complicated questions like: If physicians have a collective <\/em>responsibility to speak out during the COVID-19 pandemic, does every <\/em>physician has such an obligation? Does any individual <\/em>physician?<\/p>\n

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.<\/p>\n

In my essay I describe a family physician<\/a> inviting his extended family for a holiday meal during a peak period of SARS-CoV-2 transmission because he didn\u2019t think COVID-19 was a \u201cbig deal.\u201d<\/p>\n

More infamously, Dr. Scott Atlas served as Donald J. Trump\u2019s 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, <\/em>but he routinely promoted views starkly different<\/a> than those of physicians with expertise relevant to the pandemic, and the guidance coming from scientific and medical communities.<\/p>\n

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<\/a> of<\/a> masking<\/a>, or the safety<\/a> and benefits<\/a> of vaccination<\/a>.<\/p>\n

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 <\/em>individual obligation to speak out and do outreach \u2013 including toward the insular communities less likely to seek out medical information that Strous and Karni take to be important targets of physician outreach.<\/p>\n

A danger then when individual physicians speak for themselves as<\/em> physicians but not with<\/em> the medical community, is that they could be misconstrued as speaking both with and for<\/em> a medical community. This comes with serious risks. It is dangerous for the targets of their advocacy. It also further compromises public trust<\/a> in science.<\/p>\n

This doesn\u2019t mean physicians can\u2019t 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<\/a> 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<\/a>, coalescing and giving institutional backing to a collection of insights from scholarship and clinical practice.<\/p>\n

But when physicians speak out about COVID-19, pandemic precautions, and now vaccination \u2013 as many are and should \u2013there are good reasons to see this as part of a collective <\/em>responsibility. It is a collective responsibility in which individual physicians share<\/em>, rather than merely and individual duty.<\/p>\n

 <\/p>\n

Paper title: Physician Outreach During a Pandemic: Shared or Collective Responsibility?<\/a><\/p>\n

Author: Elizabeth Lanphier<\/p>\n

Affiliations: Assistant Professor, Ethics Center, Cincinnati Children\u2019s 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.<\/p>\n

Social media: @EthicsElizabeth<\/a><\/p>\n

Competing interests: None declared<\/p>\n

 <\/p>\n

 <\/p>\n","protected":false},"excerpt":{"rendered":"

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 […]<\/p>\n

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