MEDICO. – The medical profession occupies, by excellence and importance, first place after that of the priest.
Ancient deontological texts such as, for example, the celebrated Hippocratic oath (4th century B.C.), the prayer of Moses Maimonides (1155–1204), etc., testify to the high regard in which the practice of medicine has always been held and to the moral qualities with which one who devotes himself to it must be endowed (cf. G. Lami, Tre antichi testi deontologici, in Studium, 34 [1938], pp. 42 ff.). Touching here upon the fundamental duties of the physician, we distinguish: I: training, II: the relationship with the sick, and III: relations with colleagues.
I. FORMATION. — It is customary to speak of the need, for the physician, of a special vocation. This is true in the sense that anyone who devotes himself to medicine must possess, as indispensable requirements, certain physical, intellectual, and moral qualities, together with a particular inclination toward a way of life which, even upon external examination, appears so different from every other professional occupation.
From the physical point of view, apart from certain medical specializations that may permit relatively regular hours and undemanding duties, the physician, by the intrinsic nature of his work, must be ready at any circumstance and moment to provide his care. Unable to take account of fatigue, disgust, or a legitimate desire for recreation, he needs a robust physical constitution which, at least initially, gives him hope of enjoying good health and prevents him from too easily succumbing to the harm caused by insufficient and interrupted rest, even at the end of an exhausting day’s work; by irregular and hurried meals; and by a life largely spent in unhealthy environments, among suffering people who are always eager to pour out upon others the burden of their own afflictions. It is understandable that such harsh living conditions belong particularly to physicians on the front lines, such as those practicing in difficult «condotte», obstetricians, and surgeons, for whom fatigue and urgent work carried out under conditions of particular nervous tension are present to the greatest degree. By contrast, «specialization», particularly in certain forms, permits considerably more tranquil working conditions; even in these cases, however, good physical balance is necessary, since strongly negative aspects are present here as well (e.g., sedentary work in dentistry, the highly harmful absorption of radiation by the radiologist, etc.).
Intellectually, the physician, already at the beginning of his work, must possess a scientific formation proportionate to the breadth and complexity of his object of work, disease, and to the patient subject in whom it takes place, man, a mixed nature whose knowledge is not exhausted by that of the material element alone, but requires a particular intuition capable of penetrating also into the immaterial and even the spiritual part. The ancients had already divined the sublime height of a broad medical culture embracing all the variety and aspects of the sick man, summing it up in the aphorism: «the philosopher physician is like the gods».
Apart from his preliminary preparation, the physician cannot crystallize around a past of study and live on the income of knowledge already acquired; rather, he must follow daily the progress of a science in whose field a host of scientists are at work and upon whose achievements a legion of the sick places its hopes. This continual intellectual improvement of the physician, while representing for him a necessity from the social and (if the ugly word may be permitted) commercial standpoint of the profession, constitutes a strict moral duty for the Catholic physician, in view of the high responsibility of his mission, sedare dolorem, which has something almost divine about II.
To strictly professional science, the physician must also join careful religious and moral instruction and formation, especially on those points (e.g., the doctrine concerning Baptism and the manner of administering it, problems concerning the V, VI, and VIII Commandments, the Christian solution to the problem of suffering, etc.) that may be of greatest interest to him in his work.
Above all else, the Catholic physician needs certain moral qualities: great kindness of heart, enabling him to penetrate deeply into the intimate sufferings of his neighbor, and not merely the physical ones, and impelling him to become their healer or at least their consoler; an uncommon spirit of sacrifice, allowing him serenely to endure the hardships of the profession, which in some cases may extend even to danger of life, as well as the harassing siege of the sick and their families; the fortitude necessary to confront with determination and complete self-control difficult and distressing emergency situations; irreproachable morality, the fruit of constant mastery over his instincts and uncontrolled 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 sin for those who entrust themselves to him; and rectitude of intention, so that he does not embrace the profession solely for reasons of gain, but, apart from the legitimate desire to derive from it an honest means of subsistence corresponding to the dignity of his state, practices medicine in view of the loftiness of its social and moral ends.
The soul of all these qualities must be a Christian conception of life and of the profession.
II. RELATIONS WITH THE SICK. - The fundamental basis of the relations between physician and patient is that of care; the physician, in fact, intervenes only in order to treat. It is not enough, however, to see in the patient merely the clinical case, an object of study and experiment. He must remember that before him stands a human being who is not only body, but also has a soul with its own problems, generally intensified by illness, and which, because of the substantial unity of the human composite, exercises a powerful influence upon the patient’s physical condition itself. The physician must therefore know the psychology of the patient and seek to win his trust and confidence, so as to be able, insofar as possible, to treat, together with the diseases of the body, those
of the spirit as well (cf. P. Tournier, La medicina individuale, Roma 1947). Since, however, not all spiritual and moral problems fall within the physician’s competence and, on the other hand, the patient does not always have sufficient confidence in him to disclose them, the physician himself must appreciate the work of the priest, the spiritual physician, and, whenever he suspects or establishes that his patients are in need of it, direct them to him. The duty of this medical collaboration with the priest’s work becomes particularly grave in certain circumstances, such as, for example, in the event of danger of death.
In treating the patient, the honest physician will never permit himself to recommend remedies or perform interventions that are morally reprehensible. Were he to do so, besides violating God’s law, he might in some cases also incur serious ecclesiastical and civil penalties. Civil sanctions, however, often leave morally condemnable cases unpunished. Thus, for example, in Italy the physician who procured criminal abortions would be severely punished (cf. arts. 545-55 Cod. pen.); it is disputed, on the other hand, whether this also applies in the case of therapeutic abortion. Canon law, as is natural, likewise punishes therapeutic abortion with excommunication (can. 2350 § 1).
In almost all penal codes, as in the Italian one, severe penalties are also imposed upon the physician who administers dangerous medicines (art. 445 Cod. pen.), etc. Even when positive sanctions are not threatened, however, the physician must bear in mind the norms of natural law and remember the strict account he will have to render to God. He may not therefore cooperate, for example, euthanasia (v.) sterilization (v.), or in artificial fertilization (v.) in those forms prohibited by Catholic morality. A request on the part of the client is not sufficient to justify actions that are intrinsically dishonest because they are contrary to nature. But it is not enough, especially for the Catholic physician, merely to refrain from intervening in such cases; he must also carry out a positive apostolic work, dissuading the patient from the intention of resorting to similar procedures and inculcating sound moral principles, respect for which benefits not only the soul but also the body. A field of particular delicacy, in which the physician can accomplish very much, is that of sexuality; many disorders and injuries can be avoided, while, on the other hand, very serious consequences may be caused by imprudence or dishonesty in his conduct.
Another duty of the physician is to ensure that fees do not exceed the limits of justice and charity, especially in the case of poor patients. Issuing certificates of convenience, more or less false, all the more so in return for exorbitant payments, constitutes at once professional abuse, fraud, and theft, which even fall under the sanction of criminal law. The physician will not carry out experiments on any patient that, whether through his incompetence or through insufficient knowledge of the effects of the intervention or of the substances used, might prove harmful; experimentation will be permitted only when the patient is now certainly considered close to death and there is a well-founded hope that the remedy, whose efficacy is in doubt, may prove of some benefit to him.
In every case, and this applies to every intervention by the physician, whether the administration of medicines or surgical procedures, the principle must prevail that his work be, if not necessary, at least useful; if it cannot foreseeably bring about a cure, it should at least improve the state of health or lessen suffering, without inflicting upon the patient a danger or harm greater than that which the illness itself could produce. Respect for the dignity of the human person and for individual liberty requires that the patient’s consent exist, at least implicitly, or, in the event of his incapacity, that of those legally responsible for his guardianship.
A particularly grave duty of the physician toward his patients is professional secrecy; unlike sacramental secrecy, it may be lifted in certain circumstances in which interests of a higher order are at stake (v. SEGRETO PROFESSIONALE). In recent times the physician has also been called upon to undertake more immediately social work in the various assistance institutions. Here his task is particularly delicate and consists in reconciling, in a sound balance, the opposing interests of those receiving assistance and of the social-security institutions. He must therefore keep midway between the two opposing interests, avoiding both excessive severity and unreasonable liberality, both of which are unjust. Moreover, he must beware of regarding patients as mere numbers, without taking serious care of the circumstances of each individual.