Physician

PHYSICIAN. - The profession of the physician occupies, by excellence and importance, the first place after that of the priest.

Ancient deontological texts such as, for example, the famous oath of Hippocrates (4th century B.C.), the prayer of Moses Maimonides (1155-1204), etc., testify to the high esteem in which the practice of medicine has always been held and to the moral qualities with which the one who dedicates himself to it must be adorned (cf. G. Lami, Tre antichi testi deontologici, in Studium, 34 [1938], p. 42 ff.). In touching here upon the fundamental duties of the physician, the following are distinguished: I: formation, II: the relationship with the sick, and III: relations with colleagues.

I. FORMATION

People often speak of the need for a physician to have a special vocation. This is true in the sense that whoever devotes himself to medicine must possess, as indispensable, certain gifts of a physical, intellectual and moral order, and a particular inclination toward a kind of life that, even on an external examination, presents itself as so different from every other professional occupation.

From the physical point of view, apart from certain specializations of medicine that can allow a relative regularity of hours and tranquillity of duties, by the intrinsic character of his work the physician, who must be ready in any circumstance and at any moment to give his care, unable to take account of fatigue, of disgust, of the legitimate desire for recreation, needs a robust physical constitution that, at least to begin with, gives him hope of enjoying good health and does not make him too easily yield to the harm of scanty and interrupted rest even at the end of a harassing day of work, of irregular and hurried meals, of a life that for the most part unfolds in unhealthy environments, among suffering people always eager to pour out on others the pain of their own ills. It is understandable that, in a particular way, such conditions of hard life are proper to front-line physicians, such as those practising in poor «districts», obstetricians, surgeons, for whom the element of fatigue exists to the highest degree, of urgent work carried out in conditions of particular nervous tension. On the contrary, «specialization», particularly for certain forms, allows far more tranquil working conditions; even for these, however, good conditions of physical equilibrium are necessary, since strongly negative sides appear here too (e.g., sedentariness for dentistry, the highly harmful absorption of radiation for the radiologist, etc.).

Intellectually, the physician, already at the beginning of his work, must possess a scientific formation proportionate to the vastness and complexity of his object of work, illness, and to the patient subject in whom it unfolds, man, a mixed nature whose knowledge is not exhausted in that of the material element alone, but requires a particular intuition that reaches even into the immaterial and even the spiritual part. Already the ancients had divined the sublime height of a vast medical culture embracing all the variety and aspects of the sick man, summing it up in the aphorism: «the physician who is a philosopher is like the gods».

Apart from his remote preparation, the physician cannot crystallize around a past of study and live on the income of knowledge already acquired, but daily must follow the progress of a science in whose field a host of scientists works and in whose conquests a legion of sick people hopes. This continuous intellectual perfecting of the physician, if it represents for him a necessity from the social and (if the ugly word may be permitted) commercial side of the profession, constitutes a strict moral duty for the Catholic physician, in relation to the high responsibility of his mission, sedare dolorem, which has something almost divine about it.

To strictly professional science the physician must also join an accurate instruction and religious-moral formation, especially on those points (e.g., doctrine on Baptism and on the manner of administering it, problems concerning the V, VI and VIII commandments, the Christian solution of the problem of suffering, etc.) that can interest him most in his work.

First among others, certain moral gifts are necessary to the Catholic physician: a great goodness of soul that makes him penetrate deeply into the intimate sufferings of his neighbour, and not only the physical ones, and spurs him to become their healer or at least their consoler; an uncommon spirit of sacrifice that enables him to bear serenely the hardships of the profession, which in some cases can reach the very danger of life, and the harassing siege of the sick and their families; the fortitude necessary to face with decision and full self-control situations of emergency, difficult and pitiful; an irreproachable morality, the fruit of a constant mastery of his own instincts and unruly passions, so that he may not go so far as to abuse the privileges of his profession, sinning and becoming an occasion of scandal and of sin for those who entrust themselves to him; rectitude of intention, so that he may not embrace the profession for motives of profit alone, but, apart from the legitimate desire to derive from it an honest means of sustenance corresponding to the dignity of his state, may cultivate medicine in view of the loftiness of its social and moral ends.

The soul of all these gifts must be a Christian conception of life and of the profession.

II. RELATIONS WITH THE SICK

The fundamental basis of the relations between the physician and the sick person is that of care; the physician, in fact, intervenes only in order to cure. It is not enough, however, to see in the sick person merely the clinical case, an object of study and experiment. He must remember that before him is a man who is not only a body, but has a soul which likewise has its own problems, as a rule sharpened by illness, and which, by virtue of the substantial unity of the human composite, exercises a powerful influence on the patient's very body. The physician must therefore know the psychology of the sick person and endeavor to win his trust and confidence, so as to be able to treat, as far as lies within his power, together with the diseases of the body 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 sick person does not always have such confidence in him as to disclose them to him, the physician himself must appreciate the work of the priest, the spiritual physician, and, when he suspects or ascertains the need for it in his patients, direct them to him. The duty of this medical collaboration in the priest's work becomes particularly grave in certain circumstances, as, for example, in the case of danger of death.

In treating the sick person, the honest physician will never permit himself to suggest remedies or to perform interventions that are morally reprehensible. If he did so, besides violating the law of God, he might in some cases incur even grave ecclesiastical and civil sanctions. Civil sanctions, however, often leave morally condemnable cases unpunished. Thus, for example, in Italy the physician who procured criminal abortions would be severely punishable (cf. arts. 545-55 of the Penal Code); it is debated, on the other hand, whether this also holds in the case of therapeutic abortion. Canon law, as is natural, strikes even therapeutic abortion with excommunication (can. 2350 § 1).

In almost all penal codes, as in the Italian one, grave penalties are likewise imposed against the physician who administers dangerous medicines (arts. 445 of the Penal Code), etc. Even when, however, no positive sanctions are threatened, the physician must keep in mind the norms of natural law and remember the severe account he will have to render to God. He is therefore not permitted to cooperate, for example, in euthanasia (v.) and sterilization (v.), or in artificial insemination (v.) in those ways that are forbidden by Catholic morality. The request on the part of the client does not suffice to justify actions that are in themselves dishonest because they are against nature. But it is not enough, especially for the Catholic physician, to limit himself, in these cases, to not intervening; he must also carry out a positive work of apostolate, turning the patient away from the intention of resorting to such interventions and instilling sound moral principles whose observance benefits not only the soul, but also the body. A field of particular delicacy, and one in which the physician can do a great deal, is the sexual one; many disorders and harms can be avoided, while on the other hand even quite grave consequences can be caused by a lack of prudence or by dishonesty in his conduct.

Another duty of the physician is that his fees should not go beyond the limits of justice and charity, especially with poor patients. Issuing certificates of accommodation, more or less false, all the more so if in exchange for exorbitant compensation, constitutes at once abuse of profession, fraud and theft, which fall outright under the sanction of the penal law. On no sick person will the physician attempt experiments which, whether through his lack of skill or through insufficient knowledge of the effects of the intervention or of the substances employed, may prove harmful; the trial will be permitted only in the case where the sick person is by now considered certainly close to death and there exists a well-founded hope that the remedy, whose efficacy is doubted, may prove of some use to him.

In every case, let the principle hold for every intervention of the physician, whether it be a matter of administering medicines or of surgical interventions, that his work be, if not necessary, at least useful; if foreseeably it does not succeed in curing, it may at least improve the conditions of health or lessen the sufferings, without inflicting on the sick person a danger or a harm greater than that which the illness itself is capable of producing. Respect for the dignity of the human person and for individual freedom requires that, at least implicitly, there exist the consent of the sick person or, in the case of his incapacity, of the persons who have the right of guardianship over him.

A particularly grave duty of the physician toward his patients is that of professional secrecy; this, unlike sacramental secrecy, can be released in determined circumstances in which interests of a higher order are at stake (v. SEGRETO PROFESSIONALE). In recent times the physician has also been called to a more immediately social work in the various works of assistance. Here his task is particularly delicate and consists in reconciling in sound balance the opposing interests of the assisted and of the welfare institutions. He must therefore keep himself far from both extremes between the two opposing interests, from excessive severity and from unreasonable liberality, both of which are unjust. Let him guard, moreover, against considering the sick as mere numbers, without taking serious care of each one's conditions.

III. RELATIONS WITH COLLEAGUES

Here the physician should use the greatest correctness and cordiality, remembering that criticism of colleagues, even when justified, and all the more denigration for base motives of envy, jealousy, or self-interest, besides offending charity, often justice, and always the sense of professional collegiality, often has sad repercussions on the esteem and trust that the sick must generally place in the person of the physician. Nor will he create disloyal competition or dishonest alliances for the purpose of cornering clients; rather he will compete honestly with colleagues in healthy emulation, through assiduous study and a high sense of moral responsibility.

Luigi Morstabilini