COMMENTARY

Ignoring the Sins of Our Patients

Amy Faith Ho, MD

Disclosures

November 23, 2020

I've saved the lives of mass gunmen, gang lords, and Klansmen. I've treated serial killers, pedophiles, and terrorists of our collective society. I've dressed the wounds of a rapist and walked not 10 feet away to stitch the torn pelvic flesh of his child victim.

The moral whiplash is enough to make anyone's conscience spin.

As an emergency medicine doctor, I am obliged to treat everyone who walks, staggers, or wheels through our double doors — regardless of what walk of life they've detoured from, what sins they've committed, and what beliefs they hold.

"I will remember that I remain a member of society, with special obligations to all my fellow human beings..."

This passage from the Hippocratic Oath, recited by every newly inaugurated doctor, is noble in its essence, but it can become quite complicated in practice.

These commitments are intrinsic to our jobs, part of the oath we swear to do no harm, no matter how much harm the patient has inflicted. This was already our reality as doctors, but COVID layered a new burden on it.

As the infectious spread of a deadly virus has engrossed our everyday minds, society has become more distanced and isolated. Our friends and families have become potential infective agents. And in many cases, compassion has been superseded by survival instincts; where neighbors would normally reach out a helping hand, they now ask, "Where are the gloves?"

But while most people have pushed away from one another, we in healthcare have pulled together, converting our medical system into a COVID-fighting machine.

Even for us, though, the risks of COVID have raised the price of compassion. Spending extra time at the bedside with a COVID patient brings with it an increased risk of contracting the same illness. That risk not only affects our lives but also those of our loved ones.

When we swore to do no harm, we didn't necessarily commit to putting ourselves in harm's way. In the early months of COVID, we all weighed the uncomfortable possibility of sacrificing our own lives to treat a stranger fighting for theirs. This became even more chilling as we witnessed our colleagues succumb to this very reality.

Extraordinarily, these facts did not discourage the vast majority of us from showing up to work, day after day, night after night, shift after shift.

These workplace hazards we've now implicitly accepted as part of our allegiance to the mission of medicine. However, this personal risk does muddle the preexisting moral quandary of treating "all...fellow human beings" — especially when it comes to those cast out from society, such as prisoners.

Prisoners have been disproportionately infected with COVID, with higher rates of transmission as well as higher fatality. The reasons for this are multiple, including crowding in penitentiaries, underlying health conditions of the incarcerated, and even prisoners intentionally infecting one another to escape the prison walls.

Nonetheless, we treat these patients often in our hospitals, affording them the same therapies as everyone else.

Here we are, saving the lives of felons, some already sitting on death row. The virus tried to complete the death sentence that the law had prescribed but not yet executed. But still, we intervene aggressively — with medicines, procedures, and ventilators — all at great infection risk to ourselves.

In an era where healthcare rationing is becoming closer to reality, why should we risk our own lives, the lives of our coworkers, the lives of our families, and the resources of our hospitals for these patients?

I asked myself this same question as I treated countless prisoners with COVID, performing high-risk aerosolizing procedures like intubations, all the while praying that my N95 mask carried the same protection over numerous reuses.

As I peered over these prisoners' scared faces, I was struck by their vulnerability as they struggled to breathe. Tears collected in their eyes, millimeters from the tear-shaped tattoos that celebrated the deaths they inflicted in their former lives. In that moment, teetering in the crossroads of life and death, they were devoid of the brutal callousness of their crimes. Instead, I saw only honest authenticity as they gasped between breaths, "Help me. Please."

Help is what I gave them, and help is what we avowed to provide, under all conditions, to all people.

The integrity of modern medicine is founded on the oath of Hippocrates and relies on the fact that our role in medicine is not to judge but to treat. This frees us to believe in goodness, kindness, and redemption, at all extremes of situation.

For many — the exiled, the ostracized, and the incarcerated — society has judged and the law has condemned. But when they enter the house of medicine, we still treat them with the same compassion and care as everyone else. Every person is a life, and every life is worth saving.

Amy Faith Ho, MD, is an emergency physician, published writer, and national speaker on issues pertaining to healthcare and health policy, with work featured in Forbes, Chicago Tribune, NPR, KevinMD, and TEDx.

All views expressed are those of the author and do not represent the opinions of any affiliates.

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