Medicine is a profession, and in common parlance a “profession” is a job done well (“a real pro”) or a job that pays well. Join a profession, and your parents will never hassle you about getting a real job. Lost in this definition is the old-fashioned understanding of a profession as an occupation whose practitioners live and work according to a code, and are given certain privileges by society in return. The code sometimes means doing things adverse to your interests. If you’re a doctor, you can’t refuse to treat a Republican because you happen to be a Democrat. You can’t charge more because your patient is desperate.
You can, however, just stay home. You might get fired, but you won’t lose your license or get frog-marched back to the hospital. In that way, medicine differs from the most prominent public profession, the officer class of the military. But it shouldn’t. Medical professionals, like military professionals, should be bound to serve in pandemics, at personal risk, on penalty of expulsion from the profession. We should be able to draft doctors.
The system would be simple. To become a doctor, you would join a professional guild and incur an obligation of service, in cases of public-health emergencies. If you left your post, you would lose your medical license. (Exceptions would apply: doctors who are immunocompromised or elderly, say, or whose family situations would mean undue hardship.) Some physicians—including those in the military, the Public Health Service Commissioned Corps, or the National Disaster Medical System—have already undertaken the obligation to go where they are deployed, but most have not.
Alex Kon, a physician and bioethicist, says that until about a hundred years ago, doctors regularly fled epidemics. Only since then, after a quasi-military ethos of not abandoning one’s post penetrated the medical profession, did expectations change. Now there is an unwritten “covenant,” Kon says, according to which doctors hold their positions, and society is supposed to reciprocate by equipping them and practicing social distancing (for example) to keep their hospitals from being swamped.
Doctors have abided by that covenant. The rest of us have broken it. We have failed to equip them; we have failed to elect governments that competently manage public health; we have failed to wear masks, avoid crowds, and keep the ERs as empty as possible. Now may seem like an odd time to give new formal obligations to doctors, given their faithfulness to the covenant. But now the covenant needs renewal, and perhaps also formalization, because the burdens on each side were not evident before. The collective burden our society is placing on health-care workers should not be left to the individual consciences of individual doctors and nurses, to be sorted out at the moment of the emergency. Instead the burden should be imposed on them upon their licensure—and more to the point, it should be recognized and respected by patients and other laypeople long before a pandemic arrives.