Updated at 10:20 a.m. ET on April 26, 2020.
On Tuesday a candidate for the Connecticut Senate, J. T. Lewis of Sandy Hook, posted one of those suicidal tweets that goes off like a mortar shot straight up into the sky, with nothing to do but plummet back down onto the head of the one who fired it. Here it is, whistling back to Earth in its full contrarian glory:
The Easy Target Firing Squad rapidly assembled and dispatched Lewis. Their points were good. Doctors and nurses signed up to care—not to be thrown into infection zones with socks and T-shirts wrapped around their heads. They risk their lives with the expectation that every reasonable effort will be made to protect them as well as their patients. Whatever they signed up for, it wasn’t this.
Lewis, who is 19, eventually took down his tweet. But he was onto something. If doctors and nurses were quitting en masse, would we feel outrage with them, or at them? The coronavirus pandemic has accelerated our need for a full reckoning of the status of health-care workers: what we ask of them, and what we honor them with in return. I think we both ask too little of them and honor them too little.
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.
To send health-care workers into hospitals with too few masks is a betrayal akin to sending soldiers and marines into battle without up-armored Humvees. We tend not to think sympathetically about people whose jobs merely indicate that they have won some kind of meritocratic olympiad, and gotten the job that everyone else would love to have. But soldiers are stewards of the public trust, and that makes the public the stewards of their well-being. Any profession that can transform suddenly into vital infrastructure for the continuity of American society should be treated as such from its members’ induction. To underequip soldiers is an abomination. To underequip doctors is a supply-chain problem, a failure of hospitals to order enough masks—unless doctors are like soldiers, in which case they should be treated that way from the start.
Such a system is less foreign to the professions than you might think, and it does not require that the state take over medicine. When lawyers are admitted to practice, they become “officers of the court,” a genteel-sounding phrase that embeds certain obligations. If a court needs a lawyer to represent someone, it can (again, with some limitations) simply appoint one of its lawyers to do so. Courts rarely appoint unwilling lawyers—who would want a reluctant lawyer, anyway?—but the power of the court exists nonetheless, and a lawyer who flatly refused might not be practicing before that court for long. The possibility of being called up is, along with some amount of pro bono practice, part of belonging to a profession in which the public has deposited its trust.
(Right now there are tens, perhaps hundreds, of thousands of inmates who could plausibly claim that their cells are like staterooms on virus-stricken cruise ships, and that the prisons should release them until their confinement is safe. Perhaps state bars should draft their members, so each of these prisoners—and not only the rich and well connected—can make a case. If every lawyer in America represented one or two inmates, the job would be done.)
Of course, some lawyers became lawyers not to represent the poor or defenseless but to make a lot of money. Some doctors became doctors for the same reason. They have their reward. The good news is that medical schools have no trouble filling their classes, and if the thought of serving in an emergency deters a few greedy bastards from applying, others will replace them. Medicine will remain respectable not only for the material security of its members, but also for the integrity and possible self-sacrifice inherent in the job. Doctors and nurses didn’t sign up for this. The ones you want treating you are the ones who would sign up for it if they had the chance.