Putting
Your Ethics On Display
Philip G. Ney, MD
“Putting Your Ethics On Display” Reprinted from, CMAJ
1 April 1990: 142 (7) p752 by permission of the publisher,
Canadian Medical Association Journal © 1990 Candain medical
Association.
The Canadian Medical Association (CMA) assumes no responsibility
or liability for damages arising from any error or omission in
the text or from the use of any information or advice contained
in this material.
Last March Dr. Philip Ney1
of Victoria wrote a letter to the editor of CMAJ in which he stated
that physicians should post a statement of their ethics in their
waiting room or office and that he has had one posted for 5 years.
That letter interested Dr. Stuart Houston of Saskatoon, who in
a letter to CMAJ wondered what Ney’s statement said. Here
Ney answers that question and explains why the scroll hangs in
his office.
Pythagoras moaned quietly as he shifted his weight from one side
of the bed to the other. “At last my gloomy physician has
arrived, but what is in that vial he holds so carefully? What
are his real intentions? If I ask him directly he will tell me
only what he thinks is good for me. I suspect he really believes
my illness is incurable and so, to placate the gods, end my suffering
and collect a fat fee from my divorced wife, he’ll give me
a hearty handshake and a good dose of hemlock, I wish I could
know what a doctor’s real intentions always were.”
Hippocrates read his thoughts. “Don’t worry old man.
From now on, my colleagues and I swear by the gods not to hasten
the death of any patient, not to have sex with them and not to
abort women. Quite frankly, since we have declared our ethics
it has made our practice of medicine much easier. It seems when
patients have no doubt about our intentions, we don’t have
to spend so much time persuading them to consent and we don’t
have to worry so much about whether they like us or not.”
Some years ago I wrote an article emphasizing the utility of the
Hippocratic oath.2
My wife lovingly had the core statement of the oath made into
a scroll, which I hung in my office. For 6 years any patient or
colleague has been able to read and know my basic medical ethics.
Though there has been a wide range of reactions, the most frequent
one is relief. Even those who disagree seem glad to know where
I stand on issues such as euthanasia or abortion, although one
or two patients may not have returned because they strongly disagreed.
I have been complimented and am often asked questions – the
keen interest shown by teenagers has surprised me. Most colleagues
are politely curious. I don’t know of anyone who has imitated
this display of mine, although quite a few physicians have requested
reprints of that original article.
Putting my ethics on display has convinced me that Hippocrates
and his colleagues were basically pragmatic in formulating their
oath. When patients know my intentions it is much easier for them
to give or withhold consent. I now believe no physician can obtain
an informed consent if patients do not know his ethic.
In any case, it is a good exercise for any healing professional
to think through and succinctly state his basic beliefs about
life, its beginnings and endings, sufferings and sorrow. Publicly
committing myself to an ethic helps protect me from the subtle
fluctuations in cultural mores and the no-so subtle pressures
of government to adapt my practice for convenience or money; “Society
is always attempting to make the physician into a killer.”3
I am also rediscovering that truth is unitary: good science coincides
with good ethics.
Joe sat unhappily in his doctor’s waiting room, wondering.
“I know I’ve got AIDS but how is old Doc McLeod going
to treat me, especially when I am dying? I am such an embarrassment
to my family that I suspect they will encourage him to hurry me
along and I’m not sure how fast I want to end it all. I don’t
agree with the old ways but when all doctors took the Hippocratic
oath, people knew what their doctors believed. Nowadays they keep
revising their ethics. It has become a confusing cycle of patients
wanting to know what their doctors intend and doctors trying to
say what they think their patients want to hear. Why don’t
they display their ethics? If nothing else, it would provide a
focus for some of the issues old Doc McLeod and I must discuss.”
References
1 Ney PG: Letting patients
know where you stand. Can Med Assoc J. 1989; 140:586.
2 Idem: Ethical dilemmas
in medicine. Ann R Coll Physician Surg Can 1984:17
(6): 465-466.
3 Meade M: Introduction.
In Levine M: Psychiatry and Ethics. Braziller, New York,
1972,: vi-xvi
