This is a story of medical ethics and choices.
PSYCHIATRIC VIEWS ON THE DAILY NEWS
Most physicians will probably recall Dr Birx from her role as coronavirus response coordinator within President Trump’s White House. Recently, her book Silent Invasion, was published to present her side of the story. At its basis, it is a story of medical ethics choices.
Although I have not yet read the book, I did read the New York Times book review by David Quammen: “Deborah Birx’s Excruciating Story of Donald Trump’s Covid Response.”1
Perhaps the ethical decision most well-known occurred early on, just about 2 years ago during a televised White House briefing. In discussing disinfection chemicals that could kill SARS-CoV-2 on a tabletop, President Trump wondered if it could be used as a treatment. Dr Birx froze and looked down. Then he turned to her for a comment, and she replied: “Not as a treatment.” From then on, she was marginalized from the team, but stayed on, going around the country educating on her own until the end of that administration.
How to assess her medical ethical responses? Since she was not directly responding as a clinician seeing patients, the AMA’s Principles of Medical Ethics did not fit. But once upon a time, due to the takeover of psychiatry systems by for-profit managed care, I was asked by the American Association of Psychiatrist Administrators to put together a corresponding set of ethical principle for psychiatrist administrators.2
The administrative role, of course, brings in the responsibility to the organization in addition to the patient and to the physician’s own well-being. Besides managed care and business versus health care ethics, the multiple ethical responsibilities can occur in such systems as prison and military health care. In her case, it involved political policies.
In the Preamble to the administrative ethical principles, the key statement is:
“When conflict exists between the needs of the organization or society and the needs of patients, the psychiatric administrator must be guided by an ongoing commitment to the needs of patients. If and when the psychiatric administrator can no longer follow these principles, resignation would be an ethical option.”
Dr Birx did not take the ethical option of resignation, but quietly did follow one way of staying committed to the COVID needs of patients and would-be patients that fit her personal well-being well enough. May other physicians learn from her for the future.
Dr Moffic is an award-winning psychiatrist who has specialized in the cultural and ethical aspects of psychiatry. A prolific writer and speaker, he received the one-time designation of Hero of Public Psychiatry from the Assembly of the American Psychiatric Association in 2002. He is an advocate for mental health issues relate to climate instability, burnout, Islamophobia, and anti-Semitism for a better world. He serves on the Editorial Board of Psychiatric Times™.
1. Quammen D. Deborah Birx’s excruciating story of Donald Trump’s Covid response. The New York Times. April 21, 2022. Accessed May 2, 2022. https://www.nytimes.com/2022/04/21/books/review/deborah-birx-silent-invasion-trump-covid.html
2. Moffic HS, Saeed SA, Silver S, Koh S. Ethical challenges in psychiatric administration and leadership. Psychiatr Q. 2015;86(3):343-354.