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When Employer Demands Clash With Health Care Obligations


Many people know a physician's Hippocratic oath. It's often summarized by the phrase first, do no harm. But what about when patients are detainees in U.S. immigration centers? A group of doctors is asking if it is ethical for doctors to agree to serve in those detention centers. Paul Spiegel of the Johns Hopkins School of Public Health wrote about this in the Journal of the American Medical Association.

What is wrong with a physician thinking about going into an immigration detention facility to administer to children?

PAUL SPIEGEL: Nothing. In fact, I think it's very important and a worthwhile endeavor to do so. The issue is rather more will a physician be able to fulfill his or her Hippocratic oath by having the independence to be able to provide the standard of care that is accepted and recommended.

INSKEEP: Why wouldn't they have independence?

SPIEGEL: Well, there's something called dual loyalty where the loyalty for the physician is first and foremost to the patient, but a physician, unless they're working independently, is also working for an organization. And in this case, we have to look at, for the Department of Homeland Security, will they allow - will their decisions and the managers allow the clinicians to be able to provide the latest standard of care?

INSKEEP: Can you give me an example in which the concerns of the Department of Homeland Security would override a physician's independent judgment of what's best for a patient?

SPIEGEL: So we've seen in some detention facilities hygiene has been not acceptable in terms the provision of soap, water and sanitation. And the latest, of course, is concerns that some children have died from influenza. And then recently the Customs and Border Patrol has said that they will not provide influenza vaccines to people in their detention facilities.

INSKEEP: So there may be circumstances of very short-term detention under proper conditions that would seem fine to you, but there are many other circumstances you think doctors should have nothing to do with.

SPIEGEL: Correct, or doctors need to be able to speak out when they see something is not being handled properly. And so it's why we're also calling for an external committee to document what the standards are and then to be able to make their findings public.

INSKEEP: Suppose that an individual doctor is subscribing to your advice, wants to keep their Hippocratic Oath and the conditions just don't exist. And the choice is either I as a doctor go in and do what help I can or I just stay away. Would you tell me to stay away?

SPIEGEL: Yes - very difficult situation. There needs to be some care. And so I don't think we're advocating to say unless health care professionals can fulfill their Hippocratic oath that they should all walk out and therefore no care should be delivered. We are hoping that Congress will ensure that there are changes so that doctors can work independently in those situation and ensure that the standards are being met.

INSKEEP: Did you as a physician lose any sleep while trying to think through this problem?

SPIEGEL: (Laughter) Because of my background of working in places in the Rwandan genocide and in Syria, it's not something new for us to think through. But it's been a little bit more disturbing to see these issues occur in the United States.

INSKEEP: Paul Spiegel of the Johns Hopkins Bloomberg School of Public Health. Dr. Spiegel, thanks so much.

SPIEGEL: Thank you very much, Steve. Transcript provided by NPR, Copyright NPR.