The Ethical Consequences of Medical Objectivity

Abstract

Objectivity is a valued principle in western allopathic medicine, and for good reason: it has been very effective in saving lives and improving quality of life since the nineteenth century. In recent years, however, there have been many visible accounts in social and mass media describing the consequences of disbelief by physicians, particularly from women and people from marginalized communities. This paper uses an urban bioethics perspective to examine how overreliance on the principle of objectivity can lead to violations of bioethical principles that it should be in balance with.First, media and personal accounts of physician disbelief and misdiagnosis of patients are discussed. This is followed by a brief discussion of the historical roots of objectivity in medicine, an examination of the particular difficulty western medicine seems to have with medically-unexplained symptoms, and a closer look at specific diseases that encounter stigma in the clinical setting. From there, specific bioethical principles are analyzed. Nomaleficence is violated when clinicians traumatize their patients through disbelief of symptoms that cannot be confirmed through confirmatory testing and when they prematurely assume a psychogenic cause of symptoms simply because the cause cannot be found with a physical examination, laboratory test, or imaging study. Solidarity, autonomy, and agency are violated through the denial of the patient’s expertise in their own experience and the disempowerment of the patient in the doctor-patient relationship. Distributive and social justice are violated when the efficiency demanded of a medical system built upon reliance on objective findings disadvantages patients with difficult-to-diagnose conditions along with women and marginalized groups. Potential solutions to the unethical overreliance on objectivity include changes to medical education and culture to be more allowing of fallibility and humility, as well as better integration of mental and behavioral health into the primary care setting, so patients’ medical and psychosocial needs may be treated more holistically. Structural changes to the healthcare system allowing better physician reimbursement for clinical counseling will also mitigate dependency on objective findings for diagnosis and treatment.