OPINION
The Case for Drafting Doctors
And why this is the wrong thing to call for right now
An extremely disorganized, confusing, and infuriating article was published in The Atlantic in late April 2020. The title and subtitle are tame enough: “Doctors Are Holding Up Their End of the Bargain. Society Is Not. | Sending health-care workers into hospitals with too few masks is a betrayal akin to sending soldiers into battle without armor.”
At first glance, it seems to echo the calls made by healthcare workers for more personal protective equipment (PPE), as hospital supplies run precariously low and the number of new COVID cases continue to grow. On closer examination, however, the author has a much more insidious message. The original title (as evidenced in the URL as well as the browser tab title) was actually “The Case for Drafting Doctors”. I am unsure as to why the new title was chosen, because this title is much more representative of the author’s thesis. Instead of advocating for healthcare workers to have adequate protection at all times, Graeme Wood actually argues that doctors should be able to be drafted, so that they can be forced to work without adequate protection.
“Medical professionals, like military professionals, should be bound to serve in pandemics, at personal risk, on penalty of expulsion from the profession. We should be able to draft doctors.” — Graeme Wood
Mr. Wood, a journalist, laments the gap between working in medicine and serving in the military. However, military analogies are a poor fit when discussing health care professionals in a pandemic because the two fields have more differences than similarities. Military professionals sign legal contracts that bind them to “active duty” (a term with a precise definition) for a specific number of years. There is an understanding that by signing up, there is a real possibility of being deployed into an active war zone, and a very real likelihood of dying in combat. Members of the military are also guaranteed certain benefits like subsidized college tuition, medical and dental care, death and injury benefits, travel and housing benefits, pension and veteran benefits, etc., which serve to incentivize or compensate soldiers for taking on increased personal risk. There are no such equivalents in medicine.
“The system would be simple. To become a doctor, you would join a professional guild and incur an obligation of service, in cases of public-health emergencies. If you left your post, you would lose your medical license.” — Graeme Wood
When I entered medical school, there was no contract for me to sign besides an immunization record and criminal record check. The closest thing I can think of is the ceremonial Hippocratic Oath taken at the end of medical school. However, even the ancient Father of Medicine did not require new physicians to put their own lives at risk. There is no mention of any obligation like that anywhere in the Oath, in any version, for millennia.
Besides the intangible “respectability” that Mr. Wood mentions, there are no tangible benefits of becoming a doctor. Physicians are by and large considered self-employed small business owners/contractors who run private practices. At least in Canada, they do not enjoy additional health or dental insurance beyond basic universal health care, and cannot contribute to pension plans because of their self-employed status. Doctors have invested decades of time in school, accumulated hundreds of thousands of dollars in student debt, and have accrued the psychological and emotional stress that come with being responsible for other human lives. Thus, there is neither a legal nor moral obligation for doctors to take on personal risks of death or injury, to the extent that military professionals are expected to.
Obviously, being a doctor comes with some inherent risks, from minor ones such as catching a cold from a patient, to more serious ones like contracting HIV or Hepatitis C. Doctors do and should respond in emergencies where they are able to help, such as performing CPR on an airplane or performing first aid at the scene of a car accident. In the context of a pandemic, I do believe that doctors who are in a position where they are able to help — namely, if they have relevant training (doctors specialize and not all are trained to provide emergency or ICU care) and if they have sufficient protective equipment as mandated by health regulatory bodies — they should step up, ethically.
The vast majority of doctors are stepping up to the plate. Many are even voluntarily working with reduced and extended-use PPE, and should rightly be regarded as heroes. Doctors want to help people. Every person in a society should pitch in however they can, to help reduce the impact of an infectious disease that affects us all. However, to suggest that all doctors be placed at the same level of forced duty as military professionals, who are expected to sacrifice their lives, is simply unreasonable.
“Some doctors became doctors for the same reason [to make a lot of money]. They have their reward. The good news is that medical schools have no trouble filling their classes, and if the thought of serving in an emergency deters a few greedy bastards from applying, others will replace them. Medicine will remain respectable not only for the material security of its members, but also for the integrity and possible self-sacrifice inherent in the job. Doctors and nurses didn’t sign up for this. The ones you want treating you are the ones who would sign up for it if they had the chance.” —Graeme Wood
Regardless of what Mr. Wood wants to believe, (non-military) medicine is a civilian profession and occupation. There are many reasons why people go into medicine, just like there are many reasons why people become journalists. If either field did not offer any pay, we would be hard-pressed to find many people willing to become doctors and journalists. In my opinion, doctors are paid the way they are because of the years of training, debt, and subsequently, the knowledge and skill required to do their job. Compensation is one legitimate consideration out of many for choosing a career, and does not make someone a “greedy bastard” for considering it. It is also extremely disheartening to hear Mr. Wood equate the desire to work in a safe environment with greed. I believe that all human beings have the fundamental right to safe working conditions, including having access to adequate protective equipment.
If you want to be treated by doctors who would “sign up if they had the chance”, why not just let them sign up? Doctors are already signing up. There is no need for conscription.
Another point: conscription itself is entrenched in inequality. Both the POTUS and presidential nominee Joe Biden have received multiple draft deferments, due to bone spurs and asthma respectively. War veteran Eliot Ackerman writes:
“Vietnam taught us that unless the country is engaged in total war, a national draft is a failed model. With student deferments and various loopholes most often exclusively leveraged by the well-off, or influential, the brunt of that conflict fell to America’s poorest, most marginalized citizens, creating a toxic social rift.” —Eliot Ackerman, “Draft the Rich”, TIME
It’s not hard to imagine physicians who are in positions of power and/or influence being able to leverage similar deferment loopholes at the expense of residents (doctors-in-training dependent on completion of their residency program) and doctors from marginalized backgrounds, if a draft like Mr. Wood is advocating for is instated.
“To send health-care workers into hospitals with too few masks is a betrayal akin to sending soldiers and marines into battle without up-armored Humvees.” — Graeme Wood
Again, this analogy is contradictory to the author’s main point: advocating for the conscription of doctors to be sent into battle even if there was inadequate PPE. Why does a profession need to be conscripted in order for us to properly equip them?
Speaking of analogies, Mr. Wood presents the example that lawyers are “officers of the court”, and have the duty to potentially work pro-bono and represent a client in the event that there are not enough willing lawyers. This is wildly disproportional and completely misses the mark. The potential risk of having to work without pay is nowhere near the potential risk of dying from an infectious disease.
I have a better proposal: we should be able to draft journalists during times of war and conflict. Every aspiring reporter (including arts, culture, and film writers) should have to sign a contract before entering the profession, to be able to be deployed overseas into active war zones without adequate protection if needed. Society has the right to be well-informed, and journalists have a duty to bring us the best information, regardless of personal risk. And they should want to do it out of their sense of honour, because they are a “respectable” and “non-greedy” profession, otherwise they should not be allowed to work. I doubt many journalists or members of the public would stand behind such a ridiculous proposal.
“Doctors have abided by that covenant. The rest of us have broken it. We have failed to equip them; we have failed to elect governments that competently manage public health; we have failed to wear masks, avoid crowds, and keep the ERs as empty as possible.” — Graeme Wood
The author acknowledges that now is an odd time to call for new formal obligations for doctors, when they are not abandoning their posts. He tries to explain that the “unwritten covenant” between doctors and society still needs to be renewed and formalized so that the profession will be respected more by patients and laypeople. But what will that accomplish? Why not advocate for more protection for healthcare workers, or for a law that mandates mask-wearing in public to reduce further disease spread? Why not call for the ‘conscription’ of the public during this public health ‘war’ to stop gathering in large groups unnecessarily? Why instead take the hardline stance and argue that only doctors should be mandated to sacrifice their lives, when they are already doing so voluntarily?
In conclusion
Doctors want to help and they want to be protected, for the sake of themselves, their families, their colleagues, and their other patients. They know they have skills that others don’t, and those skills are essential right now. They want adequate protection more than empty words of praise. Doctors don’t want to be military heroes — they just want to be able to do their job safely.
