ORIGINAL

ETHICAL IMPERATIVES AND THE NEW PHYSICIAN:
VI. RESPONDING TO THE PATIENTS OF TOMORROW

COMMENCEMENT ADDRESS By
C. Everett Koop. M.D., Sc.D.
SURGEON GENERAL
OF THE
U.S. PuBLic HEALTH SERVICE
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

PRESENTED AT THE COMMENCEMENT EXERCISES OF THE
UNIVERSITY OF HEALTH SCIENCES/THE CHICAGO MEDICAL. SCHOOL
Cuicaco, ILLINOIS
June 13, 1988
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(GREETINGS TO HOSTS, GUESTS, FRIENDS, ETC.)

I WANT TO THANK THE BOARD OF TRUSTEES, THE FACULTY, AND THE
CLASS OF 1988 FOR INVITING ME TO TAKE PART IN THESE COMMENCEMENT
EXERCISES AND, ESPECIALLY, FOR THE HONOR YOU’VE CONFERRED UPON
ME,

THIS IS MY 7TH YEAR AS YOUR SURGEON GENERAL AND IT’S BEEN AN
ENORMOUSLY REWARDING EXPERIENCE. FRANKLY, I’VE OFTEN WISHED THAT
~~ SOMEHOW, EARLIER IN MY CAREER AS A PHYSICIAN -- I COULD HAVE
HAD A TURN AT PUBLIC SERVICE.
2
THE ISSUES WOULD HAVE BEEN DIFFERENT, OF COURSE. AND |

WOULD HAVE HAD A LITTLE DIFFERENT VIEW OF THE WORLD AS WELL. BUT
I MIGHT HAVE ALSO HAD MORE OF THE OPTIMISM OF YOUTH ... AND
CERTAINLY MORE OF ITS ENERGY. ALTHOUGH I MANAGE TO KEEP UP A
PRETTY GOOD PACE AS IT IS.

BUT I THINK I MIGHT HAVE TRULY BENEFITTED FROM A YEAR OR
TWO -- OR MAYBE MORE -- OF BEING FORCED TO THINK ABOUT ISSUES IN
MEDICINE AND PUBLIC HEALTH IN TERMS OF THEIR RELEVANCE TO AN
ENTIRE PEOPLE AND NOT JUST TO THE PATIENTS IN MY OWN PARTICULAR
PRACTICE.
3
DON'T GET ME WRONG. MY DAYS IN ACADEMIC SURGERY AND PRIVATE

PRACTICE WERE THE HAPPIEST, MOST PRODUCTIVE DAYS OF MY LIFE AND |
DON’T REGRET A MINUTE OF THAT TIME. NEARLY 40 YEARS, I MIGHT
ADD.

AND MY GREATEST WISH FOR EACH OF YOU TODAY IS THAT YOU MIGHT
HAVE THE SAME KIND OF LIFE -- AS PROFESSIONALS ... AND AS PEOPLE
~- THAT I WAS PRIVILEGED TO HAVE HAD.

AND THE ONLY OTHER THOUGHT I WOULD ADD TO THAT IS A WISH
THAT EACH OF YOU MIGHT FIND YOUR OWN WAY OF GETTING A HEALTHY NEW
PERSPECTIVE ON YOURSELF AND YOUR CAREER THROUGH SOME FORM OF
PUBLIC SERVICE. AND THAT YOU DO IT WHILE YOU HAVE THE ENTHUSIASM
AND THE ENERGY OF YOUTH.
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I PROMISE YOU, IT WILL MAKE YOU -- AND OUR SOCIETY -- A LOT

STRONGER.

THAT’S ONE CHALLENGE I WOULD LAY BEFORE YOU TODAY. BUT IT’S
NOT THE ONLY ONE.

IN FACT, I WANT TO USE THIS OPPORTUNITY TO SHARE WITH YOU A
FEW NOTIONS ABOUT A RATHER FORMIDABLE CHALLENGE FACING YOU, AS
YOU EMBARK ON A CAREER IN MEDICINE.

THAT CHALLENGE IS TO BEGIN -- AS SOON AS YOU CAN -- TO PUT
YOUR OWN ETHICAL HOUSE IN ORDER, TO UNDERSTAND IT, TO BE
COMFORTABLE WITH IT, AND BE PREPARED TO RELY ON IT VERY MUCH IN
THE YEARS AHEAD.
5
THIS ADDRESS, BY THE WAY, IS THE LAST ONE IN A CYCLE OF 6

MEDICAL SCHOOL COMMENCEMENT ADDRESSES I AM DELIVERING THIS
SPRING. I GAVE THE FIRST ONE A MONTH AGO IN WASHINGTON, D.C.

EACH ONE IS DIFFERENT, OF COURSE, BUT ALL ARE CONCERNED WITH
THE “ETHICAL IMPERATIVES” THAT CONFRONT THE NEW PHYSICIAN. LATER
THIS SUMMER I WILL SEND EACH OF YOU A FINAL PUBLISHED COPY OF
ALL 6 ADDRESSES. 1 DON'T WANT YOU TO MISS A WORD OF ANY OF THEM.

IF YOU’VE THUMBED THROUGH ANY NEWSPAPERS OR NEWSMAGAZINES
OVER THE PAST YEAR OR SO, YOU KNOW THAT PERSONAL AND PROFESSIONAL
ETHICS HAVE BECOME A SERIOUS CONCERN NOT ONLY FOR MEDICINE BUT
FOR AMERICAN SOCIETY IN GENERAL.
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FOR MANY GOOD REASONS, VIRTUALLY EVERY PROFESSION AND TRADE

IN OUR SOCIETY IS GOING THROUGH THE SAME AGONY OF INTROSPECTION
THAT MEDICINE IS GOING THROUGH, IN RESPECT TO THEIR CODES OF
ETHICAL CONDUCT.

ETHICS IS CURRENTLY A SUBJECT OF GREAT MOMENT TO MILLIONS OF
PEOPLE IN BUSINESS AND INDUSTRY ... IN THE LAW... IN POLITICS
© IN SCIENCE AND RESEARCH ... AND IN VIRTUALLY EVERY FIELD OF
HUMAN ENDEAVOR.

THESE SAME PEOPLE, BY THE WAY, ARE YOUR AGE PEERS ... YOUR
FELLOW CITIZENS ... YOUR NEIGHBORS ... AND SOON THEY’LL ALSO BE
YOUR PATIENTS.
/
HENCE, I AM FOCUSING ON YOUR NEED FOR A SYSTEM OF PERSONAL

AND PROFESSIONAL ETHICS TO GUIDE AND SUPPORT YOU, AS YOU STEP OFF
INTO THE WORLD OF PATIENT CARE,

WITH THE HELP OF A COHERENT SYSTEM OF ETHICS, YOU, YOUR
COLLEAGUES, AND YOUR NEIGHBORS WILL BE BETTER EQUIPPED TO
WRESTLE WITH ONE OF THE OVER-RIDING ISSUES OF THE AGE ... AND, I
SUSPECT, OF THE AGES YET TO COME,

THAT ISSUE IS THE CONTINUING TENSION BETWEEN OUR ASPIRATIONS
AND OUR RESOURCES ... OR, SAID ANOTHER WAY, THE TENSION BETWEEN
WHAT WE WANT TO ACCOMPLISH AND WHAT WE CAN AFFORD TO ACCOMPLISH,
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I’D SAY THAT ~~ FOR THE REST OF THIS CENTURY ... AND BEYOND

--- EVERY MAJOR DISCUSSION ABOUT MEDICINE AND HEALTH WILL REFLECT
THAT TENSION:
* THE INTEGRITY OF THE MEDICARE PROGRAM, FOR EXAMPLE ...
* OR IMPROVED MEDICAL CARE FOR THE HANDICAPPED ...
* OR THE IMPACT OF THE RISE IN THE NUMBERS OF OLDER
AMERICANS ...
* OR THE CHALLENGE OF SPECIFIC DISEASES, SUCH AS AIDS.

EACH OF THESE ISSUES AND MANY OTHERS SWING BACK AND FORTH BETWEEN
OUR COMMITMENT AND DESIRE TO DO MORE AND DO BETTER ... AND OUR
REALIZATION THAT WE DON’T HAVE THE RESOURCES TO DO EITHER.
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THIS IS A NEW SITUATION, ONE THAT WE’RE NOT QUITE USED TO AS

YET,

FRANKLY, WE’VE ALL BEEN A LITTLE SPOILED BY SEVERAL DECADES
DURING WHICH WE DREW UPON AN APPARENTLY UNLIMITED SUPPLY NOT ONLY
OF DOLLARS BUT ALSO OF PEOPLE, FACILITIES, AND EQUIPMENT.

BUT THAT PERIOD IS OVER ... AND WITHOUT A DOUBT, IT’S OVER
FOR GOOD. WE NOW KNOW THERE ARE LIMITS. AND SOME OF THOSE
LIMITS ARE BEGINNING TO PINCH,
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SECOND, THANKS TO AN EXPLOSION OF NEW KNOWLEDGE IN SCIENCE

AND TECHNOLOGY OVER THE PAST SEVERAL DECADES, WE KNOW HOW TO DO
MANY NEW AND FASCINATING THINGS: WE CAN TRANSPLANT MAJOR ORGANS
AND REVERSE INFERTILITY AND MIX-AND-MATCH THE GENETIC CODE AND SO
ON,

BUT KNOWING HOW TO DO SOMETHING HAS NEVER BEEN ENOUGH,
PEOPLE ALSO WANT TO KNOW WHY ... OR WHY NOT? AND TODAY, WE‘RE

ASKING “WHY?” MORE OFTEN AND MORE INSISTENTLY,

AND THE ANSWERS ARE NOT ALWAYS EASY TO COME BY.
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LAST YEAR, FOR EXAMPLE, THE STATE OF OREGON DECIDED THAT IT

HAD TO MAKE A CHOICE BETWEEN PAYING FOR 30 ORGAN TRANSPLANTS OR
FOR IMPROVED PRENATAL CARE FOR 1,500 EXPECTANT MOTHERS. THE
MOTHERS WON,

OREGON’S DILEMMA WAS ONE OF WHAT GUIDO CALABRESE, THE DEAN
OF YALE LAW SCHOOL, HAS CALLED THE “TRAGIC CHOICES” OF OUR ERA.

THE FIRST CASUALTY OF OREGON’S “TRAGIC CHOICE” WAS 7-YEAR-
OLD ADAM HOWARD, WHO NEEDED A BONE MARROW TRANSPLANT THAT WOULD
HAVE COST THE STATE $100,000. THE STATE WOULD NOT PAY AND ADAM
HOWARD DIED IN DECEMBER.
12
IN MEDICAL TERMS, A BONE MARROW TRANSPLANT NO LONGER

QUALIFIES AS “HEROIC” OR “EXTRAORDINARY” MEDICINE. BUT IT
CLEARLY DOES QUALIFY -- IN OREGON AND IN MANY OTHER PLACES, T00
-- AS “HEROIC” AND “EXTRAORDINARY” ECONOMICS.

IS OUR SOCIETY STILL READY AND WILLING TO DELIVER HIGH-
QUALITY, TECHNOLOGY-INTENSIVE MEDICAL CARE TO EVERYONE, REGARD-
LESS OF COST? 1’D HAVE TO SAY THAT SOCIETY'S ANSWER IS ...
“PROBABLY NOT.”
13
WHILE THE OREGON EXPERIENCE HAS BEEN HIGHLY DRAMATIC, THE

REAL EFFECT OF LIMITED RESOURCES IS BEING FELT, I’M AFRAID, BY
SOCIETY’S MOST VULNERABLE POPULATION GROUPS: THE HANDICAPPED ...
THE POOR AND THE DISADVANTAGED ... AND THE ELDERLY.

WE ARE ALREADY HEARING THE SUGGESTION THAT OLD PEOPLE WHO
ARE SICK -- ESPECIALLY THOSE WHO ARE TERMINALLY ILL -~ OUGHT TO
BE ALLOWED TO -- OR EVEN BE ENCOURAGED TO -- DIE AS QUICKLY AS
POSSIBLE.

BY HASTENING THE DEATHS OF OLDER PEOPLE, SOCIETY CAN MAKE
MORE MONEY AND OTHER RESOURCES AVAILABLE TO PAY FOR THE HEALTH
AND MEDICAL CARE OF YOUNGER PEOPLE.
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AND GUESS WHO WOULD MAKE THE NECESSARY LIFE-OR-DEATH

DECISIONS UNDER SUCH AN ARRANGEMENT? SOME GOVERNMENTAL OR QUASI-
GOVERNMENTAL AGENCY, ACCORDING TO THE ADVOCATES OF THIS APPROACH,

WHENEVER I HEAR THAT PROPOSAL, I ALWAYS AGREE. THEN |
SUGGEST THAT THE ,JOB BE GIVEN TO THE U.S. POSTAL SERVICE. AND
THAT TENDS TO QUIET THINGS DOWN A BIT.

BUT I AM CONCERNED TO LEARN OF MORE AND MORE INDIVIDUALS WHO
FEEL THAT IT IS ETHICALLY OKAY IF THEY THEMSELVES DETERMINE THAT
LIVING OUT THEIR LIFE UNDER LESS THAN OPTIMUM CIRCUMSTANCES IS NO
FUN AND, THEREFORE, THEY ASK -- OR INSTRUCT -- THEIR PHYSICIANS
TO HELP THEM TAKE THEIR LEAVE.
15
A GENERATION AGO, YOU WOULD HAVE BEEN HARD-PRESSED TO FIND

A PHYSICIAN WHO’D HAD AN ELDERLY, TERMINALLY ILL PATIENT WHO
ASKED OUTRIGHT TO BE HELPED ALONG TO A PREMATURE DEATH ... IN
OTHER WORDS, TO SUICIDE.

BUT NOT SO TODAY. I THINK IT’S QUITE POSSIBLE THAT MANY OF
YOU MAY WELL HAVE THAT DIFFICULT EXPERIENCE MORE THAN ONCE IN
YOUR PRACTICE. IT WILL NO DOUBT BE THE MOST TORMENTING CHALLENGE
EVER MADE TO YOUR OWN SYSTEM OF ETHICS BY A PATIENT WITH A
DECIDEDLY CONTRARY SYSTEM,
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[ THINK WE’RE UNWITTINGLY ALLOWING ECONOMICS TO DETERMINE

WHAT OUR ETHICS WILL BE. BUT THAT’S BACKWARDS AND I DON’T LIKE
IT,

I BELIEVE WE'VE GOT TO GET BACK TO THE POINT WHERE WE CAN
ONCE AGAIN MAKE SURE THAT ETHICS WILL DETERMINE WHAT OUR
ECONOMICS WILL BE.

AND WE DON’T HAVE A GREAT DEAL OF TIME TO DO THAT BECAUSE
DEMOGRAPHY IS NOT ON OUR SIDE.
17
TODAY, FOR EXAMPLE, FOR EACH PERSON WHO IS OVER THE AGE OF

65, THERE ARE 5 YOUNGER, TAX-PAYING WAGE-EARNERS TO PAY FOR
THAT ONE PERSON’S MEDICARE COVERAGE,

IN ANOTHER 20 YEARS, HOWEVER, FOR EACH PERSON OVER THE AGE
OF 65, THERE WILL BE ONLY 3 YOUNGER, TAX-PAYING WAGE-EARNERS
CONTRIBUTING TO MEDICARE.

IF WE’RE FEELING THE PINCH NOW, WHAT WILL WE BE FEELING
THEN? AND WHAT WILL WE WANT TO DO ABOUT IT?
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I MAY OR MAY NOT BE AROUND TO FIND OUT. BUT YOU WILL BE.

INDEED, YOU SHOULD BE AT THE PEAK OF YOUR CAREERS BY THEN, WITH
THE AGE AND EXPERIENCE TO BE AMONG THE LEADERS OF THE MEDICAL

PROFESSION,

AND IT MAY WELL BE YOUR LOT TO HELP SOCIETY DECIDE HOW TO
ETHICALLY RECONCILE THE GROWING DEMAND FOR HEALTH SERVICES FOR
OLDER PEOPLE WITH THE SHRINKING POOL OF MONEY TO PAY FOR THEM,

SOME OF YOU MAY WELL BE CALLED UPON TO SERVE IN AN ADVISORY
CAPACITY TO PUBLIC POLICY-MAKERS WRESTLING WITH THE RUNAWAY COSTS
OF HEALTH CARE. ALL WELL AND GOOD. I! HOPE YOU ARE,
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BUT [1 WON’T BE AN EASY TASK, IF YOU ARE ALSO INVOLVED IN

PATIENT CARE. YOU CAN’T WEAR BOTH HATS AT THE SAME TIME. THE
RELATIONSHIP BETWEEN YOU AND SOCIETY -- WITH A CAPITAL “S" --IS
NOT THE SAME AS THE RELATIONSHIP BETWEEN YOU AND YOUR PATIENTS
-- WITH A CAPITAL “P.”

AND WHAT OF THAT SECOND REASON FOR GETTING ONE’S ETHICAL
HOUSE IN ORDER ... THE NEW QUESTIONS RAISED BY SCIENCE AND
TECHNOLOGY?
20
THIS IS A COMPLICATED MATTER FOR QUITE OPPOSITE REASONS.

FIRST OF ALL, THERE ARE THE ETHICAL PROBLEMS RAISED BY SUCH
DEVELOPMENTS AS “TEST-TUBE” BABIES, SURROGATE MOTHERHOOD, GENETIC
SCREENING AND GENETIC MANIPULATION, THE USE OF FETAL TISSUE FOR
THERAPIES IN OTHER INDIVIDUALS, ORGAN TRANSPLANTATION, AND SO ON,

THESE HAVE BEEN WIDELY DISCUSSED IN BOTH THE POPULAR AND THE
PROFESSIONAL PRESS. RATHER THAN RE-HASH ALL THE ARGUMENTS, LET
ME MERELY SAY THAT WE SEEM TO BE BACK AGAIN IN THE KIND OF PERIOD
IN THE HISTORY OF MEDICINE THAT COMES IN GRAND CYCLES ... A
PERIOD WHERE SCIENCE, LAW, AND RELIGION ALL INTERSECT AND
OVERLAP.
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IT’S A CIRCUMSTANCE THAT COMES AROUND ABOUT AS OFTEN AS

HALLEY’S COMET AND, LIKE THE COMET, IT PROVIDES US WITH A RARE
DEMONSTRATION OF THE MYSTERIOUS FORCES OF NATURE, LEAVING BEHIND
A LONG TRAIL OF DEBRIS ... AND MANY UNANSWERED QUESTIONS.

THE CONJUNCTION OF THOSE THREE POWERFUL FORCES IN HUMAN
HISTORY -- SCIENCE, LAW, AND RELIGION, OR MORALITY -- IS WHAT HAS
SHAPED THE PRESENT-DAY ETHOS OF MEDICAL PRACTICE.

IN THE COURSE OF TIME, EACH OF YOU CAN EXPECT TO REACH YOUR
OWN ACCOMMODATION WITH THE CONTEMPORARY ETHOS OF PRACTICE. AND
THE RESULT OF THAT PROCESS OF ACCOMMODATION WILL BE YOUR OWN
PERSONAL SYSTEM OF MEDICAL ETHICS.
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BUT I SAID THAT THERE WAS AN OPPOSITE SIDE AS WELL, TO THIS

ISSUE OF THE NEW TECHNOLOGIES OF MEDICINE. IT’S THE DEGREE 10
WHICH THE NEW AND MOST PROVOCATIVE TECHNOLOGIES ARE REMOVED FROM
THE DAILY REALITIES OF MEDICAL PRACTICE.

IN OTHER WORDS, THE VERY TECHNOLOGIES THAT RAISE THE MOST
SERIOUS ETHICAL, MORAL, AND LEGAL ISSUES ARE TECHNOLOGIES FOR
CONDITIONS THAT ARE QUITE RARE OR ARE TECHNOLOGIES FOR CHOICES
THAT THE GREAT MAJORITY OF PEOPLE DON’T WANT TO MAKE.
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FOR EXAMPLE, I WOULD NOT FOR A MINUTE MINIMIZE THE SIGNIF-

ICANCE OF THE MORE ESOTERIC TECHNOLOGIES THAT REVERSE INFERTIL-
ITY. HOWEVER, THE POPULAR PREFERENCES FOR DEALING WITH THIS
PROBLEM ARE STILL ADOPTION, ROUTINE DRUG THERAPIES ... AND
RESIGNATION.

AS I SAY, THESE APPEAR TO BE THE PUBLIC’S PREFERENCES AND
NOT MERELY WHAT PHYSICIANS TEND TO RECOMMEND,

BUT IT’S DEEPER THAN THAT. EXCEPT FOR THOSE FEW GRADUATES
WHO PURSUE BIOMEDICAL RESEARCH OR WHO CHOOSE SPECIALTIES WITH
HIGH RATES OF TERMINAL ILLNESS, MOST OF YOU WILL SEE PATIENTS WHO
WON'T REQUIRE MUCH -- OR EVEN ANY -- HIGH-TECH CARE.
24 |
ACCORDING TO ONE SURVEY OF PHYSICIANS, THE LARGEST CATEGORY

OF PATIENT COMPLAINTS INVOLVED “CONDITIONS WITHOUT ILLNESS.”

IN OTHER WORDS, THE AVERAGE PRACTICE -- NOT JUST AMONG
FAMILY PHYSICIANS BUT ALSO AMONG MANY SPECIALISTS -- HAS A
SIGNIFICANT NUMBER OF PATIENTS WHO ARE IN RELATIVELY GOOD
PHYSICAL AND MENTAL HEALTH, BUT DON’T BELIEVE IT ... AND WHAT
THEY WANT FROM THEIR PHYSICIAN IS SOME DISPLAY OF REASSURANCE,
UNDERSTANDING, SOLACE, OR SYMPATHY ... SOME DEMONSTRATION OF
WHAT SHAKESPEARE CALLED THE “MILK OF HUMANKINDNESS.”
25
WHAT WE HAVE, THEN, IS A RISE IN THE NEW TECHNOLOGIES

AVAILABLE TO PHYSICIANS ... BUT, AT THE SAME TIME, A DECLINE IN
THEIR SIGNIFICANCE FOR A SUBSTANTIAL NUMBER OF PATIENTS,

I WOULD SAY, FOR EXAMPLE, THAT YOU MAY NEVER FACE THE
ETHICAL CHALLENGE OF PRESCRIBING A LIVER TRANSPLANT FOR A
MIDDLE-AGED EX-ALCOHOLIC. ON THE OTHER HAND, YOU WILL VERY
LIKELY BE ASKED TO RESPOND TO A VARIETY OF NON-MEDICAL BUT VERY
HUMAN COMPLAINTS -- THESE “CONDITIONS WITHOUT SICKNESS” -- WHICH
DRAW YOU MORE DEEPLY INTO THE LIVES OF YOUR PATIENTS.
26
MEDICINE HAS ALWAYS PLAYED THIS ROLE TO SOME EXTENT. TODAY,

HOWEVER, THIS KIND OF ROLE IS A SUBSTANTIAL PART OF ONE’S TOTAL
MEDICAL PRACTICE.

AND I CAN ASSURE YOU THAT THE SKILLS YOU NEED FOR IT COME
LESS FROM TEXTBOOKS AND MORE FROM YOUR OWN HEART AND SOUL.

LAST YEAR I CONDUCTED PEDIATRIC GRAND ROUNDS IN ONE OF THE
NATION'S TOP MEDICAL SCHOOLS. FOUR INTERESTING CASES WERE
PRESENTED. 1 DISCUSSED THEM TO THE BEST OF MY ABILITY. BUT WHEN
I FINISHED, I FELT COMPELLED TO NOTE THAT ALL FOUR CASES WERE NOT
EXAMPLES SO MUCH OF MEDICAL PROBLEMS AS THEY WERE OF SOCIAL
PROBLEMS.
27
AND JUST LAST MONTH I WAS IN THE NETHERLANDS TAKING PART IN

A CONFERENCE ON HANDICAPPED CHILDREN. WE BEGAN BY INTRODUCING
OURSELVES AROUND THE TABLE. AND ONE OF THE DUTCH PHYSICIANS
INTRODUCED HIMSELF AS A “SOCIAL PEDIATRICIAN.” IT WAS THE FIRST
TIME I HAD HEARD THAT TERM ... BUT I SUSPECT IT WON'T BE THE
LAST,

PHYSICIANS -- ESPECIALLY FAMILY PRACTITIONERS -- WILL ALWAYS
BECOME INVOLVED IN THE SOCIAL PROBLEMS OF INDIVIDUAL FAMILIES.
INDEED, AS A PEDIATRIC SURGEON I GOT A GOOD DEAL OF SATISFACTION
AT BEING ABLE TO FERRET OUT THE SOURCE OF A FAMILY’S ANXIETY AND
THEN TO WORK WITH THEM AS THEY DEALT WITH IT,
28
T SAY ALL THIS KNOWING FULL WELL, BY THE WAY, THAT WE

PHYSICIANS MUST GUARD AGAINST SOCIETY’S TENDENCY TO SEEK MEDICAL
ANSWERS TO ALL OF SOCIETY’S SOCIAL PROBLEMS. IT’S NICE TO KNOW
THAT THE PUBLIC THINKS SO WELL OF US THAT THEY WANT US TO CURE
ALL THEIR HEADACHES -- THE FIGURATIVE ONES AS WELL AS THE REAL
ONES.

BUT WE DON’T HAVE THAT KIND OF MAGIC. AND EVEN IF WE DID,
I DOUBT THAT SOCIETY COULD -- OR WOULD -- PAY THE PRICE FOR IT
ANYWAY, AS I‘VE ALREADY NOTED.
29
BEFORE THINGS GET TOO CONFUSING, LET ME STOP HERE AND

SUGGEST AN APPROACH FOR YOU... AN ATTITUDE ... THAT MAY HELP YOU
PRACTICE YOUR PROFESSION -- YOUR “CALLING,” WHICH IS THE TERM |
PREFER -- SOMETHING TO GIVE YOU THE WHEREWITHAL TO MAKE DIFFICULT
CHOICES EOR YOUR PATIENTS ... AND WITH YOUR PATIENTS.

FIRST OF ALL, I URGE YOU TO KNOW AND UNDERSTAND AS MUCH AS
POSSIBLE ABOUT YOUR OWN ETHICAL APPROACH TO LIFE AND TO HEALTH
CARE ... AND BE STRONG ENOUGH TO REMAIN TRUE TO IT, FOR YOUR OWN
SAKE ... AND FOR THE SAKE OF YOUR PATIENTS.
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LOOK AGAIN AT THE PEOPLE AND THE EVENTS THAT HAVE SHAPED AND

ENRICHED YOUR LIFE AND TRY TO UNDERSTAND WHY THAT IS SO. WHAT
MESSAGE DID THEY CARRY TO YOU?

AND ARE YOU, IN TURN, ABLE TO ENRICH -- AS WELL AS TO SAVE
-~- THE LIVES OF OTHERS THROUGH YOUR OWN ETHICAL CONDUCT AS A
PRACTICING PHYSICIAN?

YOUR ANSWER SHOULD BE “YES.”

AND BY BEING SUCH A PHYSICIAN, YOU WILL -- ALONG WITH A

HALF-MILLION OF YOUR COLLEAGUES -- PRODUCE WHAT IS CALLED THE
ETHICS OF THE MEDICAL PROFESSION,
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AS 1 MENTIONED AT THE BEGINNING OF MY REMARKS TODAY, THIS IS

THE LAST OF A CYCLE OF 6 COMMENCEMENT ADDRESSES I’VE GIVEN THIS
SPRING ON THE SUBJECT OF “ETHICAL IMPERATIVES AND THE NEW
PHYSICIAN,”

IN EACH OF THE PREVIOUS 5, AS IN THIS ADDRESS, I DON’T
BELIEVE I'VE ASKED ANYONE IN THE CLASS OF ‘88 TO DO ANYTHING
BRAND-NEW. RATHER, I BELIEVE I‘VE ESSENTIALLY BEEN DESCRIBING
WHAT EVERY GENERATION OF PHYSICIANS HAS HAD TO DO -- AND, TO BE
SURE, HAS DONE -- BUT PERHAPS WITHOUT AS MUCH DISCUSSION.

AFTER ALL, MY GREATEST LEGACY TO YOU WILL BE MY OWN ETHICAL
CONDUCT AS A PHYSICIAN FOR THE PAST HALF-CENTURY AND THE WAY THAT
MY CONDUCT -- TOGETHER WITH THE CONDUCT OF ALL OTHER PHYSICIANS
-- HAS HELPED BUILD A TRUE IMAGE OF MEDICINE AS AN ETHICAL
PROFESSION WITH A FIRM MORAL BASE.
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IT’S AN IMAGE THAT IS CHERISHED NOT ONLY BY THE GENERAL

PUBLIC ... AND BY OURSELVES ... BUT, MOST IMPORTANT OF ALL, IT IS
CHERISHED BY OUR SUCCESSORS, YOURS AND MINE ... BY THE GENERA-
TIONS OF PHYSICIANS WHO HAVE FOLLOWED ME ... AND BY THOSE WHO
WILL FOLLOW YOU.

AGAIN, I THANK YOU FOR YOUR INVITATION AND FOR YOUR GENEROUS
HOSPITALITY. AND LET ME EXTEND TO THE MEN AND WOMEN OF THIS FINE
SCHOOL -- ITS GOVERNORS, ITS FACULTY, AND STUDENTS -- AND MOST
ESPECIALLY TO THE CLASS OF 1988 ... MY VERY, VERY BEST WISHES,

THANK YOU,
Hee HE #