The Hippocratic Oath is a solemn pledge taken by doctors upon being admitted as a fully registered medical practitioner. The oath is taken to be a representation of the ideals of medical practice. However, these ideals may sometimes clash with the personal values held by doctors. Often, duty-bound practitioners end up overriding their own personal values in advancing the interests of their patient, such as in cases involving abortion, organ donation and end-of-life care. Doctors, at these crossroads, must decide between their values, or their duties.

However, this presents a false dichotomy. Ultimately, practitioners should recognise that a middle ground exists and this presents a haven for the conflicted doctor. This middle ground reveals itself when examined through the prism of ethical duties, inherent in the medical profession. That aside, it remains the case that doctors do face such dilemmas. Left unaddressed, it can fester and drain the motivation out of any practitioner.

What doctors commonly experience and why it matters

In dealing with difficult situations, doctors are confronted not only with the stressors exerted by the patient and corresponding family, but must also negotiate with his/her inner self on the appropriate course of action. For example, a doctor may ordinarily refuse abortion on religious grounds, but this becomes unsustainable if the life of the mother is at risk, or if the pregnancy is a result of rape.

Such inner conflicts add on greatly to the stress of medical practice and present a Gordian Knot. Eventually, doctors may find themselves losing the enthusiasm that they once had for practice and for the values they once believed in. This presents a double whammy; the equivalent of burning a candle from both ends. Thus, it is no surprise that high attrition and burnout rates are often correlated to the corrosion of an individual’s moral integrity.

An alternative point of view and a middle ground

That said, doctors should not have to reproach themselves. The apparent conflict between personal values and what is in the patient’s best interests can be reconciled – it is possible for a person to preserve his own moral beliefs while acting to the contrary.

By duty, a doctor is required to act in the best interests of his patient. This can pose a problem when doing so involves a doctor doing something deemed undesirable by his own value system, for example, abortion. Nevertheless, it is possible for a doctor to accept that the moral legitimacy of their actions, even though it is contrary to their own beliefs, stems from the notion of duty. As the Hippocratic Oath seeks to illustrate, the medical practice involves an ethical duty to help all in need, regardless of their background. To perform one’s duties despite their personal misgivings is quite possibly the highest form of reverence and respect to the Hippocratic Oath.

Even in situations where patients act in defiance to their own detriment, such as refusing treatment, a doctor can nevertheless maintain the moral high ground. The perspective here is that patients are equally at liberty to refuse treatment as they are to accept treatment. That being the case, the inability of the doctor to convince them to accept treatment should not be taken to be a failure to carry out their duties. After all, the exercise of autonomy by the patient should be considered as valuable, if not more, than the betterment of the patient’s health.

Role-differentiated morality

Ultimately, duty is not mutually exclusive from moral value. The performance of duty in and of itself is one of the cornerstones of medicine, a calling of the highest order. The Hippocratic Oath is explicit in its reference to ethical obligations and values, and embodies a duty to assist selflessly. Hence, casting aside one’s personal considerations in performing an ethical duty should be celebrated as itself a moral act, and doctors should pride themselves in being able to perform these duties to the best of their abilities. MIMS

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Medical Registration Regulations 2010 containing Singapore Medical Council Physician’s Pledge 2010.
Transforming Lives: NUS Celebrates 100 years of University Education in Singapore (Singapore University Press Ltd, 2005), page 11