Military Medical Ethics and Dr. Conley’s Misrepresentations of the President’s Health

What is it about the symbolic power of a lab coat? In 1961, the sociologist Howard Becker titled his great book about the transition from medical student to physician Boys in White. Also around that time the psychologist Stanley Milgram found that some ordinary people were willing to impose pain on strangers at the command of a scientist in a lab coat.

By standing at the platform in a white coat, the physician to the President, Dr. Sean Conley, and his colleagues leveraged the special trust and confidence that societies endow to their healers. The “white lab coat” symbolizes the unique role that we bestow on members of the medical profession.

Truth telling wasn’t traditionally part of that role. Historically doctors routinely lied or at least concealed the truth from patients, concerned about overburdening them with bad news that no one wants to tell. Dressed up in fancy terms like “therapeutic privilege,” that began to change in the 1960s. Now patients expect their doctors to tell them what’s ailing them and even to participate in their medical decisions with informed consent.

Today’s patients rely on their physicians to be truthful and professional in carrying out their duties and responsibilities. Those ethical standards apply to military physicians as well. Military commanders depend on the truthfulness and professionalism of their physicians to advise them in making critical decisions, such as authorizing a pilot to get back into the cockpit, deeming a soldier to be fit to deploy, allowing an officer to stay in command, etc. For the commanders to sustain confidence in the advice of their physicians, they must trust that their doctors unfailingly exercise the courage to provide unvarnished truth. To witness military physicians bending or burying the truth does long-lasting damage to the confidence required for the system to work.

Doctors taking care of powerful leaders have long engaged in cover-ups, including in service of democratically elected heads of state as well as dictators. In the days of a tightly controlled press that wasn’t difficult. But in our time the failure to extend truth telling about their leaders to the general public was blindingly clear in Dr. Conley’s obvious prevarications in his updates on the president’s medical condition. Bound by the rules of privacy embodied in the law, Dr. Conley could disclose only the information that the President had expressly authorized — nothing more, and nothing less. Fair enough. But he went further. He intentionally and knowingly misrepresented the President’s health and treatment.

One interpretation of Dr. Conley’s rationale for some of his misstatements has been to paint a rosier picture for the president himself, perhaps to reassure him about his prognosis. If so that would be an invocation of the outdated therapeutic exception and might have given his patient false reassurance. Or perhaps Dr. Conley was obfuscating for another audience: the American public. In either case his decision cannot be justified.

This episode has illustrated how times and public expectations have changed. When a doctor speaks to American people about the condition of a leader that physician functions as a crucial membrane in that public’s understanding about the stability of their government. The polity’s expectations are and ought to be different than they were even a few years ago. Dr. Conley was obligated to object to any order to knowingly deceive the public about the President’s medical condition. That principle must become part of an explicit standard of ethics for the next physician in the position of Dr. Conley and his white coat.

Photo: Sean Conley(L), Physician to US President Donald Trump, and White House Chief of Staff Mark Meadows listen while an update on the President’s health as he is treated for a COVID-19 infection at Walter Reed Medical Center October 4, 2020, in Bethesda, Maryland. (Brendan Smialowski AFP via Getty Images)

 

About the Author(s)

Stephen Xenakis

Stephen N. Xenakis, a psychiatrist and retired Army Brigadier General, serves on the executive boards of The Center for Ethics & the Rule of Law at the University of Pennsylvania and is an Adjunct Professor at the Uniformed Services University of Health Sciences. Follow him on Twitter @SteveXen.

Jonathan Moreno

Jonathan D. Moreno is the David and Lyn Silfen University Professor at the University of Pennsylvania where he teaches medical ethics and health policy. His most recent book is "Everybody Wants to Go to Heaven but Nobody Wants to Die: Bioethics and the Transformation of Health Care in America." Follow him on Twitter @pennprof.