PHYSICIAN. – The profession of the physician holds, by its very nature and importance, the first place after that of the priest.
Ancient deontological texts, such as, for example, the famous Hippocratic Oath (4th century B.C.), the prayer of Moses Maimonides (1153-1204), etc., bear witness to the high esteem in which the practice of medicine and the moral qualities required of those who dedicate themselves to it have always been held (cf. G. Lami, Tre antichi testi deontologici, in Studium, 34 [1938], p. 42 sqq.). In outlining here the fundamental duties of the physician, we distinguish: I. training, II. relations with patients, and III. relations with colleagues.
I. TRAINING
It is often said that a physician must have a special vocation. This is true in the sense that one who devotes himself to medicine must possess, as indispensable, certain qualities of a physical, intellectual, and moral nature, and a particular inclination toward a way of life that, even at a superficial glance, appears so different from any other professional occupation.From a physical standpoint, apart from certain medical specializations that may allow for a relatively regular schedule and calm performance of duties, the intrinsic nature of the physician’s work—who must be ready at any moment to render care, without regard for fatigue, disgust, or the legitimate desire for leisure—requires a robust physical constitution. This constitution should, at least initially, give hope of good health and prevent the physician from easily succumbing to the harm of insufficient and interrupted rest, even after a grueling day’s work, irregular and hurried meals, and a life largely spent in unhealthy environments among suffering individuals who constantly seek to transfer their burdens onto others. It is understandable that such harsh living conditions, which are not typical of pioneering physicians, also apply to those practicing in “disadvantaged” areas, obstetricians, surgeons, and others for whom the element of fatigue, urgent work, and particularly nerve-wracking conditions is most pronounced. Conversely, specialization, especially in certain fields, allows for much calmer working conditions; even in these cases, however, good physical balance is necessary, as there are strongly negative aspects (e.g., the sedentary lifestyle of dentists, the harmful absorption of radiation for radiologists, etc.).
Intellectually, the physician, from the very beginning of his work, must possess a scientific training commensurate with the vastness and complexity of his subject—the disease—and the patient in whom it manifests, namely, man, a composite being whose knowledge cannot be limited to the purely material element but requires a particular intuition capable of penetrating even the immaterial and spiritual aspects. The ancients already intuited the sublime heights of a broad medical culture embracing all the varieties and aspects of the sick person, summarizing it in the aphorism: “My philosopher is like the gods.”
Apart from this foundational preparation, the physician cannot remain fixed on past studies or live off the capital of already acquired knowledge; instead, he must daily keep pace with the progress of a science in which a host of scholars work and on whose advances a legion of the sick pin their hopes. This continual intellectual refinement, while representing a necessity from the social and (if the ugly word is permitted) commercial standpoint of the profession, constitutes a strict moral duty for the Catholic physician in light of the high responsibility of his mission: to alleviate suffering, which is almost divine in nature.
In addition to strictly professional science, the physician must also cultivate a careful religious and moral education, particularly on points (e.g., doctrine on Baptism and its administration, issues concerning the Fifth, Sixth, and Eighth Commandments, the Christian solution to the problem of suffering, etc.) that may most directly concern him in his work.
Among the other qualities necessary for the Catholic physician are certain moral virtues: a great goodness of heart that enables him to deeply understand the inner sufferings of others—not just physical ones—and to become their healer or at least their comforter; an uncommon spirit of sacrifice that allows him to serenely endure the hardships of the profession, which in some cases may even reach the point of endangering his life, as well as the relentless demands of patients and their families; the fortitude needed to face difficult and pitiful emergency situations with decisiveness and full self-control; irreproachable morality, resulting from a constant mastery over his own unruly instincts and passions, so as not to abuse the privileges of his profession by sinning and becoming an occasion of scandal and sin for those who entrust themselves to him; and rectitude of intention, so that he does not embrace the profession solely for motives of gain but, aside from the legitimate desire to earn an honest livelihood commensurate with the dignity of his state, practices medicine with a view to the loftiness of its social and moral ends.
At the heart of all these qualities must be a Christian conception of life and of the profession.
II. RELATIONS WITH PATIENTS
The fundamental basis of the relationship between physician and patient is care; the physician intervenes only to heal. It is not enough, however, to see in the patient merely a clinical case, an object of study and experimentation. He must remember that before him stands a human being who is not merely a body but also possesses a soul, which has its own problems—usually exacerbated by illness—and which, due to the essential unity of the human composite, exerts a powerful influence on the patient’s very physical condition. The physician must therefore understand the psychology of the patient and strive to earn his trust and confidence, so that he may, as far as possible, heal not only the diseases of the body but also those of the soul (cf. P. Tournier, La medicina individuale, Rome 1947). Since, however, not all spiritual-moral problems fall within the physician’s competence and, on the other hand, the patient does not always have sufficient confidence in him to discuss them, the physician himself must recognize the work of the priest, the spiritual physician, and, when he suspects or ascertains such needs in his patients, direct them to him. The duty of this medical collaboration with the priest’s work becomes particularly grave under certain circumstances, such as, for example, in cases of danger of death.In treating the patient, the honest physician will never suggest remedies or perform interventions that are morally reprehensible. If he were to do so, in addition to violating the law of God, he might in some cases incur serious ecclesiastical and civil penalties. Civil penalties, however, often leave morally condemnable acts unpunished. Thus, for example, in Italy, a physician who procures criminal abortions would be severely punishable (cf. arts. 545-55 of the Penal Code); it is debated, however, whether the same applies to therapeutic abortion. Canon law, as is natural, punishes therapeutic abortion itself with excommunication (can. 2350 § 1).
In almost all penal codes, including the Italian one, severe penalties are also imposed on the physician who administers dangerous medicines (Italian Penal Code, arts. 445), etc. Even when no positive sanctions are threatened, the physician must observe the norms of natural law and remember the strict account he will have to render to God. It is therefore not permissible for him, for example, to cooperate in euthanasia (q.v.) or sterilization (q.v.), or in artificial insemination (q.v.) when these are prohibited by Catholic morality. The request of the patient does not justify actions that are in themselves dishonest because contrary to nature. But it is not enough, especially for the Catholic physician, merely to refrain from intervening in such cases; he must also actively engage in apostolic work by dissuading the patient from resorting to such measures and instilling sound moral principles whose observance benefits not only the soul but also the body. A particularly delicate field in which the physician can do much is that of sexual matters; many disorders and harms can be avoided, while on the other hand serious consequences may result from imprudence or dishonesty in his conduct.
Another duty of the physician is to ensure that his fees do not exceed the limits of justice and charity, especially with poor patients. The issuance of complaisant, more or less false, certificates, particularly when done for compensation, constitutes at once an abuse of profession, fraud, and theft, falling even under penal law. The physician shall attempt no experiments on the sick that, whether through his own inexperience or insufficient knowledge of the effects of the intervention or the substances used, might prove harmful; such experimentation shall be permitted only when the patient is already deemed certainly near death and there is reasonable hope that the remedy, whose efficacy is doubted, might prove of some benefit to him.
In every case, whether administering medicines or performing surgical interventions, the principle must govern the physician’s work that it be, if not necessary, at least useful; if it cannot be expected to cure, it should at least improve the patient’s condition or alleviate suffering, without exposing the patient to danger or harm greater than that which the disease itself might cause. Respect for the dignity of the human person and for individual freedom requires that, at least implicitly, the patient’s consent be obtained, or, in case of his incapacity, that of those who have the right to act as his guardians.
A particularly grave duty of the physician toward his patients is that of professional secrecy; unlike sacramental secrecy, this may be broken in certain circumstances when higher-order interests are at stake (q.V. PROFESSIONAL SECRECY). In recent times, the physician has also been called to a more immediately social role in various charitable works. Here his task is particularly delicate, consisting in reconciling in a balanced way the opposing interests of the assisted and the welfare institutions. He must steer a middle course between excessive severity and unreasonable leniency, both of which are unjust. He must also avoid treating patients as mere numbers, without giving serious attention to each one’s condition.