COVID-19 has brought out the best in people, and also the worst. Daily on social media or in the news, I read heartwarming examples of generosity and kindness that challenge me to be a better person. The doctors, nurses, therapists, and chaplains who are selflessly risking their lives, sometimes with substandard personal protective equipment (PPE), rekindles in me the passion for patient care that brought me to medicine in the first place. Similarly inspiring are stories of doctors and nurses taking time to comfort dying patients, whose families not allowed to be with them out of fear of contagion. Seeing people thank supermarket and food delivery personnel for making sure we are able to eat during the shelter in place melts away some of my cynicism and compels me to be more patient and express greater gratitude. However, the flip side is also true. Across the spectrum, we have seen how badly some people behave. More than one story has emerged of people hoarding medical supplies and PPE, dramatically marking up the price so as to turn an exorbitant and unjustified profit from the pandemic. Perhaps even more morally compromising is the authoritarian response that we have seen from leaders, both global and local. In a recent article that I wrote, I point out the clear moral and public health threat that results when essential health information is suppressed, and legitimate safety concerns are silenced. Most troubling to me as a physician, is how other physicians and nurses have been silenced, shamed, and fired for bringing up legitimate concerns. Arguably the example that has resulted in the most unnecessary global human suffering is that of Dr. Li Wenliang. Dr. Li was silenced by Chinese authorities after warning colleagues of the possibility of a new SARS (severe acute respiratory syndrome) like virus. China’s Public Security Bureau detained Dr. Li, ordering him to stop illegal activities or face punishment. Dr. Li has emerged as a martyr in China, particularly in his deathbed call for greater government transparency. I agree with Dr. Li’s belief that had word of a potentially new infectious disease gotten out sooner, countless lives could have been saved. Without proper training or equipment, a team from the Centers for Disease Control and Prevention (CDC) was deployed to California in order to help process Americans evacuated from China and other areas with high rates of COVID-19 infection. After a whistleblower raised concerns to senior officials at the CDC about the potential risk of infection and inadequate PPE, the whistleblower’s “emotional stability” was questioned. Discrediting those who raise legitimate concerns by questioning their “emotional stability” seems to be a trend in authoritarian responses. Then acting Secretary of the Navy Thomas Modly implied that Captain Brett Crozier was emotionally “overwhelm[ed]” when Crozier alerted Naval superiors about what he saw as the Navy’s inadequate response to COVID-19 aboard his ship. One sailor from that ship has since died from COVID-19. In almost every interview with doctors and nurses that I have read, the sources ask not to be identified because of concern of retaliation. This concern is well-founded. Physicians have been fired for raising concerns about the adequacy of PPE and COVID-19 testing at their institutions. Nurses have been asked to simultaneously care both for COVID-19 patients, even when they lacked adequate PPE, as well as babies and patients with cancer. When concerns about the lack of PPE and the risk posed to non-COVID-19 patients, the nurses’ concerns were either dismissed, or they were threatened with termination. I want to believe that the people suppressing information and burying legitimate concerns are not bad people. I don’t think they intend the harm they cause. I do think they have lost sight of their moral compass, their empathy. I think in many instances, they place institutions, reputations, and profits before people. Unfortunately, in the long run, the cost of this is very high. By silencing legitimate concerns and suppressing information, the “speak up” culture that makes hospital care safer for patients, risks being dismantled. Given the number of already burned out and dissatisfied doctors and nurses, I am concerned that the sort of authoritarian responses that have met pleas for PPE and legitimate safety concerns, sometimes by other physicians and nurses, will further erode the moral backbone of medicine. There are only so many ethical affronts that doctors and nurses can take before they lose faith, regardless of the incentives to continue. Charles E. Binkley is a bioethicist and general surgeon. He is principal and founder, ProNobis Health. Source
