Non-judgmental regard can show the best of humanity

On July 24, 1998, a psychotic schizophrenic gunman entered a side entrance at the U.S. Capitol. As he approached Rep. John DeLay’s office, he exchanged fire with two Capitol Police officers who later died of their wounds. The gunman was badly wounded as well.

Senator Bill Frist, a cardiologist, was leaving the Capitol when Congressional aides informed him that some men needed urgent medical assistance.

A New York Times article tells more of this fascinating story:

[Frist] took off his coat and ran past the police barricade. ”I’m Senator Frist,” he told an officer, flashing his ID. ”I’m a doctor.”

The police, still fearing there was more than one shooter, ushered him down a long marble corridor that smelled of gunpowder. He knelt by the first victim, checking his wounds and inserting a breathing tube. He lifted him on a stretcher and assisted paramedics as they wheeled him into an ambulance. But before they could close the door, the patient went into cardiac arrest. Although Frist helped to shock back his heartbeat, he was certain the man would die from his injuries.

A medic yelled that there were more victims inside, and Frist rushed back into the building to treat another of the wounded, a slight man who was lying on the carpet and bleeding heavily. An artery in his chest was severed, and Frist concentrated on stemming the flow of blood. He then rode along with him in the ambulance, keeping him alive by forcing oxygen into his lungs. Only as they approached the hospital did he learn that the man he had rescued was the accused gunman, Russell Weston Jr. ”You’re not a judge; you’re not a jury,” Frist later explained. ”You’re a physician.”

The story encapsulates what I find to be the most extraordinary and difficult tenet of modern medical ethics: “non-judgmental regard.” Physicians are supposed to take patients exactly as they are, without judging or discriminating. In principle, then, the armed robber and the man he injured, in neighboring beds in the ER, are provided the same degree of care. The morbidly obese smoker with a heart attack should be treated with the same earnestness as the thin one. Judgments of worth or character are independent of treatment.

Non-judgmental regard can show the best of humanity. The medical journal Lancet offered a first-hand account of the conditions in Libyan hospitals at the front lines of their civil war. Although the doctor-journalist worked in a hospital run by rebels, many patients were pro-Gaddafi soldiers, who were provided the same level of comfort and care as every other patient.

Because I’ve decided to become a medical student, I have to make medicine’s ethical precepts my own. But I have a difficult time with shedding judgment. I don’t treat people equally in my own life. I have friends, acquaintances, and enemies, and I care about some of them more than others. In clinic, some patients’ stories touch me more than others’. One patient had developed a crippling Parkinsonian tremor, probably secondary to his addiction to meth that he tried and failed to kick. His circumstances were wrenching and I especially wanted to help this man. My next patient, a woman with conjunctivitis who lambasted me for fumbling at first with the blood pressure cuff, was less inspiring. Some patients are especially kind to me in a way that I particularly want to reciprocate.

Don’t all doctors necessarily judge patients differently? How would one diagnose Munchausen’s if one unquestioningly believed the patient’s narrative? For that matter, doesn’t specializing mean deciding that a certain class of ailments matter more to you than another?

I’m not sure that “non-judgmental regard” is utopian or a necessary precept of medical practice. In a world where no one was judged, there would be no such thing as justice, morals, ethics, or a need for self-improvement. Humanity is rich and varied–why not treat it as such?

There are two worthy attitudes here: respecting each person equally and accepting them as they are; and being sympathetic and rewarding kindness with kindness. Are they mutually exclusive, or can they dovetail?

“Reflex Hammer” is a medical student who blogs at The Reflex Hammer.

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