One of the essential ethical foundations of medicine is that there is one standard that we apply to everyone. Everyone, regardless of their “VIP” status. Recently, Vice-President Pence visited the Mayo Clinic, and in violation of their stated policy, he did not wear a protective mask as he visited with patients and administrators. The White House subsequently disclosed that Mr. Pence’s press secretary, Katie Miller, has tested positive for COVID-19. As a result of Mayo Clinic’s breach in its own stated standards, multiple people may have unwittingly been infected with COVID-19. By allowing Mr. Pence to ignore scientific data and institutional policy by not wearing the required and appropriate protective mask when meeting with patients and staff at the Mayo Clinic, the clinic abdicated their essential moral authority.
Security guard Calvin Munerlyn was fatally shot at the Family Dollar store in Flint, Michigan, on May 1, after denying a customer entry because the customer was not wearing a protective mask. This epitomizes moral courage. Mr. Munerlyn was not only enforcing scientifically based policy, but he was also protecting everyone else in the store. At its most basic, wearing a protective mask so as to not transmit the virus is a measure of social reciprocity. We follow basic standards of protection against contagion reciprocally, not just for ourselves but for our neighbor. Of note and directly applicable to Mr. Pence, it is one of the basic Christian precepts, the Golden Rule, “Do unto others as you would have them do unto you.” (Matthew 7:12)
This medical ethical cornerstone, often referred to as “one standard for all,” is essential for the moral conscience of medicine and also to maintain public trust. If in the administration of treatments, medical providers used social or political status to determine who gets what, or who is exempt from required standards, we would be violating the very oath to which we all swore. The Hippocratic Oath mandates against anything that is harmful to patients, or more broadly, to the public. This is the bedrock on which the moral foundation of medicine is based. Rich, poor, powerful, lowly, majority, minority; it doesn’t matter. Just as justice should be blind in its administration, so too should medicine.
If we fail to uphold this standard, not only do we risk the erosion of our own personal and collective conscience, but even more devastating, we risk the loss of public trust in medicine and its institutions. If the public cannot trust hospitals, health care organizations, and doctors to apply standards justly and equitable, and to have a process of accountability in place, then we have failed the very patients for whom we pledged to care. History tells many stories of the disastrous outcomes that occur when we do not apply consistent medical standards across social or political status, the so-called “VIP Syndrome.” Eleanor Roosevelt may have died because doctors, intending to spare the former First Lady pain, did not perform a bone marrow biopsy, which was the medical standard.
It may have been uncomfortable, perhaps even embarrassing, for administrators, physicians, nurses, and patients to have asked a VIP like Mr. Pence to wear a mask. He’s a powerful man. So too is the Mayo Clinic a powerful organization. In the words of advice to Peter Parker (Spider-Man), “With great power comes great responsibility.”
Charles E. Binkley is a bioethicist and general surgeon. He is principal and founder, ProNobis Health.
Image credit: Shutterstock.com
