Medical Ethics, the Physician and Society

Dr. Michel E. Abs

Secretary General of the Middle East Council of Churches

This intervention was delivered at the Symposium on Medical Ethics and Human Dignity

There is no profession equivalent to the medical profession in terms of the danger it presents in terms of people's health, longevity, and ability to work and produce. Therefore, the doctor occupies a prominent place among the professionals of modern society, and sociology of work research has classified the medical profession in the highest category of professions that enjoy social appreciation, praise and prestige.

Laws provide protection and immunity for the doctor, commensurate with the seriousness of his work as a person concerned with people’s lives and safety. The powers of some of these laws depend on the limits of confidentiality of the profession, which is a confidentiality with relatively wide limits, because it includes the privacy of the patient’s health status, which no one has the right to access except with a legitimate justification. This leads to the fact that the doctor enjoys relatively high freedom in some areas, allowing him great independence in practicing his profession, especially since he is the one who diagnoses, treats and deals with the problems that may result from the effects of treatment.

The problem is that medicine is not classified among the exact sciences, as thousands of variables that cannot be counted or that may occur during or after treatment are involved in diagnosis and treatment.

In this wide field of freedom, given to the physician, and despite the Hippocratic oath, the physician may stray from the path in one way or the other, and the consequences of his straying are unforgivable due to the repercussions of his decisions, and thus the effect of his possible misguidance, on people's lives.

We say this and we are certain that if there are some doctors who have lost their way, then the overwhelming majority of them treat humanity with all the knowledge and morality they have acquired that was not available in the past. In addition, we have all read and heard about "miracles" performed by doctors in the recovery of patients whose health condition was classified as hopeless. The reports that we have  read about doctors have carried out condemned practices that do not harm the honor, or rather the sanctity, of the medical profession.

This principle is one of the constants of our approach and view of the matter, despite everything that will be mentioned later in my speech or in the words of the ladies and gentlemen who are about to lecture to us.

With the population growth, the bifurcation of medical specialties due to the bifurcation of diseases, the steady progress in medical specialization that was accompanied by the bifurcation and diversity of medical specialties, the rise in the number of doctors, and the infiltration of the profit mentality into the minds of mankind in general, it was necessary for medical institutions, whether dealing with treatment or research, to develop laws and regulations established in order to control work in the medical, preventive and treatment fields with special emphasis given to research.

In order to prevent excess in diagnosis and error of practice from going too far, whenever present, it was necessary to have controls adopted by diagnostic and treatment medical  institutions based on two elements:

The first element is the legal element that regulates the profession and sets controls for it, based mainly on government legislation and its practical applications at the level of institutions.

The second element is the moral element that guarantees the implementation of laws and regulations as well as respect for such controls resulting from them. This second element is based on establishing and consolidating a system of values ​​and standards of behavior based on the guidance of a specialized group of experts in the field of medical practice.

Similarly, medical institutions appoint committees for medical ethics, both professional and research, and these committees, have come up with a set of a legal system formulated in order to protect society from any possibility of error in the medical field. This system is what sets the rhythm of work and prevents it medical practice to fish in troubled waters, or at least to start doing so.

These committees, which supervise the application of laws, regulations, and procedural measures, constitute, along with the concerned courts, protection for people from any intended or unintended error, and any tampering with the fate of people, whether at the therapeutic level or at the research level.

These committees, which abound in universities and hospitals, are the guarantee for any error or injustice that may be inflicted on people, and they constitute a deterrent element for any possibility that may lead a doctor into misguided practice should he be among the few practitioners  pleaded guilty whenever judged as inclined to do .

For example, the accuracy with which we deal in the "Scientific Ethics Committee" at Saint Joseph University, of which I am a member, is exemplary, as we do not leave a single variable, no matter how small, to pass unnoticed, without scrutiny and without giving it whatever discussion and evaluation it requires. This applies to all research projects, and medical projects as well as their derivatives. This also applies to all universities that are concerned with scientific research and have academic accreditation, which are classified among the high-ranking universities.

What is important in all of this is not only the enactment of laws, the establishment of regulations, and the drawing up of procedural measures, nor for that matter the establishment of specialized committees. If the application of laws in general takes place only at the level of agencies and procedural measures, we would need a policeman and a court assigned to every human being . The important thing is that the principles included in laws and regulations develop into a culture, and that the system of values ​​of the medical body becomes imbued with it, just in the same way as any other professional body is, so that the controls come from people, from their minds, consciences and values, and that the law is developed in all cases to deter those who have lost their way.

It is imperative, then, that professional, medical and other ethics become a culture inasmuch as they are laws and tools of reward and punishment, a culture that separates the white thread from the black thread, a culture that defines the limits of honor and shame in the practice of any profession, and the medical one is the most dangerous one at that, a culture that constitutes the indisputable agent in charge of serving people and taking care of their interests, the most important of which are their health and life longevity.

This approach in our thinking flows into the logic of building social capital, the guarantor of social cohesion, preserving people's interests and dignity, rather than supporting greedy preying professionals who are after securing their own wealth at any cost.

I conclude by saying that those who honor the profession of medicine, and those who practice medical ethics in their daily lives, do not do so out of the fear of punishment or fear of blame, nor are they in search of praise, but rather because their culture and values ​​make them behave properly in the appropriate way because this culture and these values ​​have become part of their very being.

Therein lies the great success in preserving the dignity of professions, of professionals as well as of society.