Preparing physicians to contend with the problem of dual loyalty

Abstract

Dual loyalty is defined as, particularly as it pertains to the field of medicine, a conflict or potential conflict between a healthcare professional's simultaneous obligations–expressed or implied–to a patient and to a third party. Dual loyalty situations often compromise physicians' ethical behavior, leading them to participate, either knowingly or unknowingly, in human rights violations perpetrated by a third party, often the state. Classic dual loyalty situations include the participation of physicians in state-sanctioned torture or the death penalty. However, there are a number of other dual loyalty scenarios that arise routinely in clinical practice in both closed institutions such as prisons, psychiatric facilities, and the military and in open societies promulgated by discriminatory practices, policies, and laws that can lead physicians and other health care professionals to contribute to the violation of individuals' human rights. Healthcare professionals are, for the most part, not formally trained to contend with these dual loyalty conflicts. While physicians routinely learn about bioethical frameworks to assist them in resolving difficult clinical dilemmas created, for example, by modern technology that extends life or by limited resources, few are taught a human rights framework that can assist them in protecting patients' human rights in cases of dual loyalty. This paper presents a case-based approach that utilizes a human rights framework for teaching dual loyalty in the undergraduate medical education curriculum. The medical profession is in dire need of training its workforce to grapple with the myriad dual loyalty issues that confront the profession today, and must institute curriculum reform to prepare future health care professionals to deal with dual loyalty scenarios that threaten individuals' human rights.

Note

Acknowledgments

The author would like to thank Reena Karani, MD, Ross MacDonald, MD, and Gail Smith, as well as the anonymous reviewers, for reviewing the manuscript and providing their invaluable insights and comments.

Notes

1 The study conducted by Cotter, Chevrier, El-Nachef, Radhakrishna, Rahangdale, Weiser, and Iacopino (2009) has not been repeated, thus updated figures regarding the prevalence of HHR training in schools of medicine and public health today are not available.

Additional information

Notes on contributors

Holly G. Atkinson

Holly G. Atkinson, MD is clinical professor and medical student advisor at the CUNY School of Medicine in New York. Prior to joining the faculty at CUNY, she was at Mount Sinai for 10 years, where she was director of the Human Rights Program. In that capacity, she founded and directed the Mount Sinai Human Rights Clinic, where asylum seekers who have suffered torture, human trafficking, and other human rights violations are medically evaluated. Dr. Atkinson also served on the board of directors of Physicians for Human Rights for more than 16 years, including four years as president.