On January 18, the U.S. Department of Health and Human Services announced the formation of a new “Division of Conscience and Religious Freedom within the HHS Office for Civil Rights. As the chief clinical officer at Howard Brown Health, the largest LGBTQ health care organization in the Midwest, I am alarmed by this assault on the integrity of the medical profession and its potentially dangerous impact on patient care.
The medical oath is one of the oldest binding covenants. It remains a rite of passage for medical graduates; beyond the symbolic value, it articulates the principles that inspire us to become health care providers as well as the responsibilities that come with the role. The evolution of the medical oath tells a story of how medical care can cause harm when it is informed by racial, ethnic, and religious biases.
In the late 1940s, following World War II, the actions of physicians in Nazi Germany and experiments carried out by the imperial Japanese army led to a crisis of faith in the professionalism and ethics of health care providers. Since then, physicians have actively perpetuated harm and withheld treatment, as in the Tuskegee Syphilis Experiment that was only ended in 1972. Physicians took actions that were informed by racial, ethnic, and religious biases and faced few consequences or none. In response to these atrocities, the World Medical Association revised the medical oath and renewed the use of this ethical tool in medical programs around the world.
The oath outlines the responsibilities of the health care provider, including “the health and well-being of my patient will be my first consideration.” In addition to respecting the autonomy and dignity of the patient, it does not permit considerations of age, disease or disability, creed, ethnic origin, nationality, race, sexual orientation, social standing, or other factors to intervene between my duty and my patient.
This announcement threatens the central tenets of medical ethics and invites discrimination. The most harmful aspect of this is that it prioritizes the needs of the medical provider above the needs of the patient. It holds that the medical provider’s religious belief is a superior directive and supersedes the need of the patient and goes against all the principles that health care providers swear to uphold.
We will continue to advocate for measures that protect vulnerable populations against harmful health care stigma and discrimination. We will fight to educate health care professionals in the appropriate strategies to attend to the unique needs of LGBTQ people with dignity and respect.
It’s what our patients deserve — my conscience tells me so.
DR. MAGDA HOULBERG is chief clinical officer of Howard Brown Health, the Midwest’s largest LGBTQ nonprofit health care organization. Founded in 1974, Howard Brown Health serves more than 27,000 adults and youth each year in its diverse health and social service delivery system focused around four major programmatic divisions: clinical care, research, education, and advocacy.