Physicians' Elusive Public Health Duties

Abstract

Law, consistent with bioethics and medical norms, directs physicians to “put patients first.” To what extent do physicians have broader responsibilities for community health, beyond and even counter to those owed to their patients? More salient in the era of COVID-19, the question of physicians’ obligations to safeguard the health of non-patients continually vexes courts, policy makers, and scholars. This Article reveals how physicians’ public health duties are confoundingly elusive. Elusive in the sense that while at times affirming physicians’ special capacity and obligations to improve the health of the community, law more often obscures physicians’ public health duties with limited, ad hoc recognition and insufficient theorization. These public health duties are also elusive in actual application. Physicians can point to individual patient obligations as reasons to evade compliance with certain public health laws or to discount public health considerations in clinical decision-making.

The strong patient-primacy directive has underappreciated costs. It frequently overrides physicians’ more elusive public health duties in ways that facilitate externalization of health risks to the general public. This Article analyzes the COVID-19 pandemic, antibiotic resistance, infectious disease reporting, the opioid crisis, and gun violence as disturbing examples. It further identifies important justifications, including, most importantly, role indispensability for amplifying physicians’ public health responsibilities.

Note: Funding: None to declare.

Declaration of Interests: None to declare.

Keywords: public health, physicians, duties, COVID-19, nonpatients