Besides The President’s Hubris & Candor, Critical Issue For Public Is Candor From President’s Doctors- Adhering To Hippocratic Oath, Military Oath, AMA Oath Or Trump Oath?

This morning, Physician to the President of the United States, United States Navy Commander Dr. Sean Conley addressed reporters from Walter Reed National Military Medical Center in Bethesda, Maryland. 

Dr. Conley avoided, evaded, and refused to provide details as to the President contracting Coronavirus (Covid-19).  He likely did so at the specific instruction of President Trump.  He was obeying an order from the Commander-In-Chief. 

Note: Dr. Conley’s predecessor as Physician to the President of the United States, during a 2018 briefing self-discredited with a lack of candor and the statement (“… he might live to be 200 years old.”) and then upon his departure, received a promotion and was later nominated (prior to withdrawing) by the President to be United States Secretary of Veterans Affairs.  He is now the Republican Party nominee for a seat in the United States House of Representatives- with the support of President Trump.

Unfortunately, Dr. Conley’s performance (which is how President Trump would describe it) revives mention of an event five years ago.  On 3 March 2015, the Defense Health Board (DHB) submitted its report “summarizing the findings and recommendations from our independent review on Ethical Guidelines and Practices for U.S. Military Medical Professionals.”  There were two primary focuses: 1) How can military medical professionals most appropriately balance their obligations to their patients against their obligations as military officers to help commanders maintain military readiness?  2) How much latitude should military medical professionals be given to refuse participation in medical procedures or request excusal from military operations with which they have ethical reservations or disagreement? 

The issues on 3 October 2020 are similar to what was asked on 3 March 2015:  Candor by physicians- particularly when the occasion is during a pandemic, involves the use of experimental drugs, is within one month of a national election, and the patient is the President of the United States seeking re-election. 

Confirmed at the event this morning was President Trump has received through a “compassionate use mechanism” from the FDA a treatment in clinical trials from Regeneron Pharmaceuticals (REGN-COV2) and a five-day antibody therapy from Remdesivir along with other medications and over-the-counter products.  There is no indication that he has ingested bleach, as he once suggested might be worth investigating. 

The questions reporters did not ask, but should have asked:  1) Has the President instructed his medical team to withhold any information about his condition?  2) If so, what information has he instructed not be disclosed?  3) Why would the President not want the public of know everything about how he contracted the virus, treatment for the virus, his medical condition, etc., so the public could learn from experience. 

For the President, those who contract Coronavirus (Covid-19) or have a headache, indigestion, etc., are weak.  Sick equates to weak.  

Commentary throughout Saturday has focused upon the belief that the reason for the lack of information from Dr. Conley (and on-the-record statements from The White House) is due to concern by the President that connectivity between his decisions relating to the pandemic and his contracting Coronavirus (Covid-19) would be detrimental to his 3 November 2020 re-election prospects.  This is true, in part. 

The primary reason is, however, founded within the concept of hubris- excessive pride or self-confidence, enjoined with a belief that a demonstration, a confirmation of any weakness is unacceptable.  And, should there be a confirmable episode of compromise, the required reaction is to deflect.   

For President Trump and members of his immediate and extended family and staff, wearing a mask represents weakness.  At first, President Trump would not wear a mask because he did not want to appear weak, afraid.  Then, a mask was created with the Presidential Seal printed to one side; the President then wore it- and specifically mentioned the Presidential Seal: It’s always about the presentation.  He soon reverted to no mask- he would show that he had one in his pocket, but in his pocket it would remain. 

What to watch for next:  The White House will maintain that President Trump was not careless as to with whom he met or was near.  It was due to the negligence of an individual or group (including the United States Secret Service).  He contracted Coronavirus (Covid-19) because someone who was weak gave it to someone who was strong (not wearing a mask)- it was that person who did not protect him; he or she did not follow the rules- even though the President ignores the rules created and implemented by the United States government.  Convoluted logic?  Absolutely. 

For the country, the worst outcome for President Trump is not to have an impactful experience with Coronavirus (Covid-19).  For him to develop empathy for others, if he is capable for doing so, he needs to suffer. 

However, President Trump believes if he is perceived as vulnerable, then his domestic agenda and foreign agenda are (not may be) in jeopardy.  He believes he is irreplaceable.  As such, he will not project, nor permit others to project on his behalf, that he is weak in any way.  If that requires a physician(s) lying for him, so be it. 

No one can replace him- that includes Vice President Mike Pence.  As then Mr. Trump said during the 2016 campaign, only he can do what must be done.  For President Trump there is no United States Government.  There is only the personification of him as sole decider-in-chief. 

Outcome modeling analysis, a predictor, would does not indicate illness, incapacitation or death of President Trump resulting in other country leadership, friendly and not, reacting, to use President Trump’s favorite descriptive, “strongly.”  The important unknown is whether the strength of response would be for the positive or for the negative- might doors open that have been closed?   

Quite unlikely that country leadership would believe any decision taken while President Trump is treated for Coronavirus (Covid-19) would be met differently if President Trump was healthy.  They have three-and-a-half years of modeling analysis, some of which based upon actual events, to determine what they want to do and when they want to do it.  Most significantly, these leaders appreciate that what President Trump wants to do is often separated from what the United States Government- deep state or sunshine state, wants to do and ultimately decides to do.  Sometimes, the implementation by the United States Government is far more substantive than would have been what President Trump would have implemented.   

There may be a majority of the populations within the 193 member nations and states of the United Nations, the thirty members of NATO, the 164 members of the WTO, and the memberships of the G7 and G20 along with the voters in the United States are not too unhappy, and some are downright jubilant, that President Trump has succumbed to Coronavirus (Covid-19). 

Any delight is not necessarily and predictably due to the policies President Trump advocates, but rather his behavior and his choice of words to explain what he is doing.  Many don’t like him and don’t like his family.  Don’t like those who work for him.  Some want him to suffer.  Some want him to die.  And, die painfully. 

Would be impactful for President Trump to be photographed in his pajamas wearing a bathrobe adorned with the Presidential Seal- harkening to the images of then-President Ronald Reagan who appreciated that there was strength in showing him recuperating.

A recovered President Trump, gainful of empathy, appreciative of the unknown, would be welcomed.   

The citizens of the United States would benefit mightily from his candor about his experience with the Coronavirus (Covid-19).  Those physicians who are caring for him need to impress upon him that transparency is critical not just for benefit of the patient, but for whom the patient works- the 330.3 million people in the United States.  

The Military Oaths 

“By virtue of the “Oath of Office,” a sworn obligation to support and defend the Constitution, Army Medical Doctors, are members of the Army Profession and they are medical professionals.” 

Oath of Enlistment: I, _____, do solemnly swear (or affirm) that I will support and defend the Constitution of the United States against all enemies, foreign and domestic; that I will bear true faith and allegiance to the same; and that I will obey the orders of the President of the United States and the orders of the officers appointed over me, according to regulations and the Uniform Code of Military Justice. So help me God." (Title 10, US Code; Act of 5 May 1960 replacing the wording first adopted in 1789, with amendment effective 5 October 1962). 

Oath of Commissioned Officers: I ___, do solemnly swear (or affirm) that I will support and defend the Constitution of the United States against all enemies, foreign and domestic; that I will bear true faith and allegiance to the same; that I take this obligation freely, without any mental reservation or purpose of evasion; and that I will well and faithfully discharge the duties of the office on which I am about to enter. So help me God. (Title 5 U.S. Code 3331, an individual, except the President, elected or appointed to an office of honor or profit in the civil service or uniformed services)  

Hippocratic Oath 

I swear by Apollo the physician, and Asclepius, and Hygieia and Panacea and all the gods and goddesses as my witnesses, that, according to my ability and judgement, I will keep this Oath and this contract:  

To hold him who taught me this art equally dear to me as my parents, to be a partner in life with him, and to fulfill his needs when required; to look upon his offspring as equals to my own siblings, and to teach them this art, if they shall wish to learn it, without fee or contract; and that by the set rules, lectures, and every other mode of instruction, I will impart a knowledge of the art to my own sons, and those of my teachers, and to students bound by this contract and having sworn this Oath to the law of medicine, but to no others. 

I will use those dietary regimens which will benefit my patients according to my greatest ability and judgement, and I will do no harm or injustice to them.  I will not give a lethal drug to anyone if I am asked, nor will I advise such a plan; and similarly I will not give a woman a pessary to cause an abortion.  In purity and according to divine law will I carry out my life and my art.  I will not use the knife, even upon those suffering from stones, but I will leave this to those who are trained in this craft.  Into whatever homes I go, I will enter them for the benefit of the sick, avoiding any voluntary act of impropriety or corruption, including the seduction of women or men, whether they are free men or slaves. 

Whatever I see or hear in the lives of my patients, whether in connection with my professional practice or not, which ought not to be spoken of outside, I will keep secret, as considering all such things to be private.  So long as I maintain this Oath faithfully and without corruption, may it be granted to me to partake of life fully and the practice of my art, gaining the respect of all men for all time. However, should I transgress this Oath and violate it, may the opposite be my fate. 

American Medical Association Code of Ethics (post-1980) 

Preamble: The medical profession has long subscribed to a body of ethical statements developed primarily for the benefit of the patient. As a member of this profession, a physician must recognize responsibility not only to patients, but also to society, to other health professionals, and to self. The following Principles adopted by the [AMA] are not laws, but standards of conduct which define the essentials of honorable behavior for the physician. 

II. A physician shall deal honestly with patients and colleagues, and strive to expose those physicians deficient in character or competence, or who engage in fraud or deception. 

III. A physician shall respect the law and also recognize a responsibility to seek changes in those requirements which are contrary to the best interests of the patient. 

IV. A physician shall respect the rights of patients, of colleagues, and of other health professionals, and shall safeguard patient confidences within the constraints of the law. 

V. A physician shall continue to study, apply and advance scientific knowledge, make relevant information available to patients, colleagues, and the public, obtain consultation, and use the talents of other health professionals when indicated. 

VI. A physician shall, in the provision of appropriate patient care, except in emergencies, be free to choose whom to serve, with whom to associate, and the environment in which to provide medical services.  

VII. A physician shall recognize a responsibility to participate in activities contributing to an improved community.