A Doctor's Duty

Around the world, hearts were broken when news came that the conjoined Bijani twins had died on the operating table. Having lived in tortured unity for 29 years, they traveled from their native Iran to Singapore for the surgery meant to set them free. The doctors who performed it were devastated. When you lose a patient, particularly when the patient dies at your own hand, the heartbreak mixes with unbearable guilt. The doctors are asking themselves the same question everyone else is asking: Should they have done it?

The doctors certainly knew the risk. They knew that with the women's shared circulatory systems, the risk was great. They might have underestimated the technical challenges, but they did not deceive their patients. The sisters, highly educated and highly motivated, knew full well the risk of never waking up from the surgery.

Indeed, they never did. Should the surgeons have attempted such a risky procedure on patients who were not dying, and, in fact, were not even sick?

For all the regrets and second guesses, it is hard to see how the answer could have been anything but yes. The foundation of the medical vocation is that the doctor is servant to the patient's will. Not always, of course. There are times when the doctor must say no. This was not such a time.

Consider those cases in which outside values trump the patient's expressed desire. The first is life. Even if the patient asks you to, you may not kill him. In some advanced precincts--Holland and Oregon, for example--this is thought to be a quaint idea, and the state permits physicians to perform "assisted suicide." That is a terrible mistake, for the state and for the physician. And not only because it embarks us on a slippery slope where putting people to death in the name of some higher humanity becomes progressively easier.

Even if there were no slippery slope, there is a deeply important principle at stake: doctors are healers, not killers. You cannot annihilate the subject you are supposedly serving--it is not just a philosophical absurdity, it constitutes the most fundamental violation of the Hippocratic oath. You are not permitted to do any harm to the patient, let alone the ultimate harm.

There are other forms of self-immolation, less instantaneous and less spectacular, to which doctors may not contribute. Drug taking, for example. One could say, The patient wants it, and he knows the risks--why not give him what he wants? No. The doctor is there to help save a suffering soul from the ravages of a failing body. He is not there to ravage a healthy body in the service of a sick and self-destructive soul.

Doctors are not just biotechnicians. They must make judgments about, yes, the soul. Before serving a patient's will, doctors have to decide whether it is perverse and self-destructive. One has to ask what kind of plastic surgeon would repeatedly do his work on Michael Jackson. Or on the Manhattan socialite, known now as the cat woman, who had her face tweaked so many times that it changed inexorably into that of a feline.