Ethical considerations in medicine: unity and open discourse

Navigating the complexities of medical ethics in our modern world can present significant challenges. It’s worth considering a deeper examination of this issue. In the year 2023, the global landscape is rapidly evolving across various spheres. As a former pediatric resident physician in New York City, I had the opportunity to witness an extraordinary range of social diversity. The city is truly a melting pot, embodying a diverse tapestry of life experiences. New York City, in many ways, stands as a microcosm of the diverse experiment that is America itself.

In our daily medical practice, we encounter genuine hurdles—better described as unique considerations—such as matters of faith, religion, ethnicity, sexuality, gender, personal identity, language, and disposition. Negotiating these considerations is a part of our responsibilities, all while upholding the Hippocratic Oath and respecting our own faith and beliefs. Currently, pertinent issues are being both openly debated and silently contemplated. Topics like gender-affirming care and abortion are at the forefront. These concerns hold particular significance for pediatricians and obstetricians, as we must navigate the intersection of the Hippocratic Oath, personal convictions, and the legal framework. To simplify, we must balance patient, faith, and law, with the aim of ensuring the well-being of all parties involved.

The medical landscape has witnessed a rise in the use of puberty blockers, gender reassignment surgeries, and gender-affirming therapies, even among younger individuals. Some therapies can commence and conclude before the age of 18, occasionally without parental knowledge of their child’s gender identity. This situation extends to questions of parental rights and informed consent, which have sparked considerable discourse. One notable case is that of Chloe Cole, who underwent hormone therapy and bilateral mastectomy at the age of 12, concluding before 16. While some individuals express regret after undergoing penectomy, vaginoplasty, or other gender-affirming procedures, the majority remain in support. It’s interesting to note that support is rarely extended to those who choose to leave certain groups. From a neurobiological viewpoint, brain development is largely established by the age of 25, marking the transition to adulthood. This developmental phase plays a crucial role in shaping our identities, often through youthful errors that provide valuable life lessons. While many errors are amendable, the irreversible consequences of pharmacological interventions and surgical procedures on minors warrant careful consideration.

Abortion is another contentious topic that merits thoughtful dialogue within the health care sphere. Differing beliefs on when life begins—whether at conception or birth—are deeply rooted in faith and personal identity. These contrasting viewpoints drive passionate efforts to save lives or uphold reproductive rights. Such discussions even extend to cases where abortion procedures result in live births. It is important to note, though, that fostering open discussions on these topics can lead to a deeper understanding of diverse perspectives.

In my humble opinion, unity within the medical community is essential to address these issues. Without public trust, the foundation of medicine becomes precarious. My engagement on these matters has prompted conversations from a multitude of individuals, underscoring the need for respectful dialogue. Moving forward requires embracing truth, transparency, and honesty. While these concepts are distinct, they all demand careful attention not only from physicians but from all those involved in patient care.

This vocation is not a personal possession; it involves serving humbly under the Hippocratic Oath, valuing the sanctity of life and its inherent worth. We treat all lives with the utmost respect, evident even in the reverence we afford those who donate their bodies for medical education. However, there seems to be a disconnection between the reverence for cadavers and the respect given to living patients. While uncomfortable, acknowledging this dissonance is crucial. As professionals and as humans, we’re tasked with seeking truth—even in the face of difficult questions that many avoid. Viewing these issues through different lenses highlights their complexity. While discomfort might arise, it’s a necessary part of catering to an increasingly diverse population. I remain committed to raising my voice, despite the cacophony of differing opinions, with the hope of fostering a meaningful conversation. This is a cause worth championing—a hill where I stand firm. If this hill isn’t worth standing for, then no other hill is worth inhabiting. Wishing you all the best.

Andrew Zywiec is a physician.

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