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Medical ethics in a changing world: Navigating identity and patient care

My buddy John and I fortuitously found ourselves enacting roles in an impromptu theatrical production last week. As medical practitioners, the thematic essence was predictably centered around matters concerning patients. The scene unfolded thus:

“So, this person’s name is Emily, but her pronoun is ‘they,’” John started. “She identifies as a therian belonging to the Elf theriotype. Emily explained to me that though she was born human, she is an inseparable part of a community of Elves, which is why describing her as a ‘she’ instead of ‘they’ is not just inappropriate but disrespectful to members of her community …”

“Whoa! Whoa! Wait, what? You play too much, bruh! Stop!” I interjected.

Yet, John maintained a resolute demeanor. He proceeded to recount how, throughout the interaction with this 26-year-old patient of his, she persistently intervened, objecting to what she perceived as the misapplication of pronouns. The situation was incredulous, leaving me utterly confounded.

Therians, as I later discovered, constitute a segment of a broader collective known as Otherkin, a subculture comprising individuals who identify as partially or entirely non-human. The specific animal species with which a therian aligns is termed a theriotype, and in Emily’s case, it is the Elf. Frequently, they employ the term “species dysphoria” to articulate their sense of detachment from their human form and their innate yearning to embody their theriotype. Some individuals also adopt the identity of “transspecies.”

Upon returning home from work that day and throughout the ensuing night, my ruminations were consumed by John’s encounter with the therian, which strikingly paralleled my own experience from the past. I recalled a previous encounter with a male patient who expressed a desire to be addressed as “she.” Similar to John, I found myself grappling with the appropriate response, compounded by the absence of a clear hospital policy to navigate such intricate challenges. All I could endeavor to do was maintain composure and uphold a professional demeanor amidst the ambiguity.

In today’s landscape, doctors are required to function as legal advocates, protecting hospitals from litigation, adept at maneuvering through the complexities of private insurance, and guardians of conservative and liberal ways of life, all while, like a stenographer, meticulously documenting every clinical and non-clinical interaction. Consequently, the precious time available for direct patient care diminishes.

The prevailing notion is that if an action is not documented, it’s as if it never occurred. Many hospitals operate as profit-driven entities, viewing decisions solely through the lens of financial gain.

The world is undoubtedly becoming increasingly complex and deeply divided. It’s challenging to find a significant number of individuals willing to engage in objective analysis and logical discourse. Instead, many are content with perpetuating one-sided narratives from their echo chambers, fostering animosity towards those with differing perspectives. The consequence of such dichotomy is that we engage in a game of ping-pong when addressing issues like Emily’s, with one side demonizing her and others advocating for letting her be whatever she decides to be. In my opinion, both approaches fall short.

Medical education fails to adequately prepare individuals for navigating the intricate and ever-evolving ethical dilemmas in the field. Hospitals often lack clear policies, offering only vague responses when confronted with such challenges, as they themselves grapple with the absence of definitive solutions.

Physicians are taught that their primary duty is to diagnose and treat patients and to heal. Yet patient care represents just one facet of the multifaceted roles they are expected to assume. Graduates soon realize they are thrust into a myriad of responsibilities for which they are ill-prepared.

Even for a physician who identifies as fiscally conservative and socially liberal, it is imperative to find a nuanced approach to addressing societal issues. While I cannot endorse a trillion-dollar defense budget when thousands of Americans struggle to access basic preventive health care, and millions are burdened by overwhelming student loan debt, I also advocate against permitting biological males to share restroom facilities with my daughter or compete against her in athletic events.

Contrary to the fallacies being spewed in divisive political rhetoric, it is possible to uphold conservative principles while supporting sensible gun regulations and equitable social programs. Similarly, one can advocate for liberal values without blindly accepting the new normal situations that may indicate an undiagnosed medical condition.

Our world is fraught with challenges, complicating the noble task of caring for the sick. Yet, by establishing agreed-upon rules and fostering mutual understanding, we can coexist in a semblance of peace and harmony. I yearn for a return to an era when doctors could dedicate the majority of their time to patient care, unencumbered by the vagaries of present-day ethical quandaries.

Osmund Agbo is a pulmonary physician.

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