Public health policy; the role of doctors in relation to the military
This week's New England Journal of Medicine offers three publicly available full-text articles that raise thorny questions about the profession's relationship to government.
One addresses the considerations that must be balanced when a medical professional offers advice to a campaign or government. The advisers occupy:
... a role awash in ambiguity, opportunity, and risk. The adviser is the president's ally — in the lingo of organizational economics, an "agent" serving the interests of a "principal." Yet as a bearer of specialized knowledge, the adviser is also responsible to a larger profession, to its values and commitments, and ultimately to the ideal of expertise itself.The adviser, in short, must both "speak truth to power" and aid in the exercise of power, both offering unbiased intelligence and acting as a very biased assistant. It is fashionable to pretend these two roles are the same, but they are not. An expert adviser has special knowledge, training, and skills — all of which are needed more than ever in the White House. The question is whether these talents can really be used, or be useful, in the bare-knuckles world of American politics — and, more important, whether the values they embody can be upheld when science, advocacy, and democracy collide.
Even higher stakes, affecting individual patients, are involved, when a physician serves in, or with, the military. Such doctors must deal with questions such as whether to help in the interrogation of prisoners (some of whom have died in U.S. custody); whether to force-feed prisoners who refuse to eat; what standards to use in certifying soldiers to be deployed, or re-deployed, for combat; and whether to use psychotropic drugs as a way to get psychologically damaged soldiers back into combat.
A third article examines in more detail the conflict between the military and the profession over the issue of physicians over interrogation. In some cases, the article says, what doctors are asked to do directly violates professional standards.
The timing of these articles, particularly the latter two, ties in with today's anniversary of the 2001 terrorist attacks as the profession and the military continue today to deal with consequences of those attacks. I welcome discussion on the issues and questions they raise.
Comments (1)
To report abuse of the comment feature on this site, please use the feedback form at the bottom of any page.
Lex, neither you nor your newspaper have given a tinker's damn about a physician in public service who stood on principle and spoke truth-to-power (on behalf of a patient) in Asheboro . . . and was professionally crucified for it (getting no help - ZERO - ZIP - NADDA - from the government she served).
Why do you care what doctor's in the military do? Unless, of course, it serves a political agenda?
The entire military medical structure is ruled not by skill, but senority/rank and power - and is therefore RIPE for abuse of that power. It happens every day - and it's ALWAYS been that way (no matter who is in the White House).
If standing on principle means bucking orders, you risk everything - because nothing will squash you/end your career faster than talking back to a well-placed superior.
Posted on September 12, 2008 3:11 PM