October 1981 III/2"DON'T BE JUDGMENTAL"
Physicians and other health care professionals often encounter patients who are involved in self-destructive or anti-social behavior which is repulsive or disagreeable. For example, a physician may be asked to treat a married man who, by reason of his many hetero and homosexual liaisons, has contracted venereal disease on several occasions. The physician, valuing fidelity in marriage, is repelled by the patient and would like "to give him a piece of my mind." The situation may be exacerbated if the physician knows the patient's wife and children. The same reaction might beset other health care professionals as they work with drug addicts and chronic alcoholics. More subtly, these reactions might occur when patients or families wish to have life-supporting means discontinued and the physician wishes to continue them. In face of these situations, where there is a conflict of values between the health care professional and a patient, the health care professional is usually advised: "Don't be judgmental!"
Values and Personality
As usually interpreted, the slogan, "Don't be judgmental," means that the health care professional should suppress his or her responses to the patient that arise because of different value systems and treat the patient as though there was no conflict. But for two reasons, I submit that this is an unhealthy and self-destructive method of working with patients. First of all, if the physician or other health care professional tries to suppress value responses, he or she will become ethically schizoid. If one pretends that one can use one set of values in personal life and others in professional life, one will soon disvalue what was formerly valued. Because of the different roles that one has in these areas of human endeavor, some values may be stressed in personal life and others in professional life, but one should never work under the delusion that there is such a thing as "value free" human activity. Assuming that "value free" human activity is possible is in itself a value statement which denies most of the values traditional to civilization, the Judeo-Christian culture, and humanism.
Values, standards by which one judges proper or fitting human behavior, reflect what it means to be human and to enter into relationships with other human beings. Values affect every level of human activity: biological, emotional, social and spiritual. Formed through education, experience and reflection, values are an important part of one's personality, self-esteem, integrity, and quest for the absolute in which we are all involved. To leave values at home when one goes to the clinic, the laboratory, the operating room, or the intensive care unit, is to leave behind a most important part of one's personality.
Secondly, abandoning values during the hours of professional practice is detrimental to the health care professional because it means the health care professional will become a slave of other people. Scientists convicted of performing atrocities during WW II offered as their only explanation: "We did it because we were told to do it." Though this example concentrates upon the ultimate, it does demonstrate that scientists or physicians who abandon values soon are at the mercy or power of patients, supervisors, politicians, or planners. The example of horror and inhumanity generated through atrocities in WW II brought the scientific community to realize the danger of pretending there is such a thing as "value free science" and demonstrated the effect such a pretense has upon scientists themselves.
A Different Interpretation
What then is the physician or health care professional to do when working with patients with whom he or she has a value conflict? Should the physician tell the patient to find someone else for treatment, or tell the patient that he will not be worthy of treatment until he leads a better life? Of course not! Rather, there is within the profession of medicine some values that will enable health care professionals to resolve conflicts in a helpful manner. Professions are based upon the supposition that people are trying to become better human beings. That is why they come to professionals for help. The professional must value this quest of betterment and realize it demonstrates the basic goodness of the person. To put it another way, when we have a value conflict with another, we must avoid concluding that the other person is "bad"and I am "good." Rather, we must first realize that the value difference may not be serious or important. Secondly, even if it is serious or important, we must realize that the basic goodness of the other person is the factor which should dominate our relationship. Moreover, we share with the person with whom we disagree the reality that we too are weak and flawed. The professional relationship is not one of superior to inferior, even though the professional has greater skill and knowledge, but rather one of equal to equal because of the basic dignity, destiny, and rights of each person. Valuing the other person then should help the health care professional avoid any detrimental or damaging remarks, moralistic reactions, or self-righteous posturing.
Occasionally a serious value conflict may cause the physician to withdraw from serving a patient because the patient requests an action that would compromise the values of the physician. If a patient requests a prescription of drugs which are not medically indicated, or if one requests less than proper medical care in order to hasten the death of a relative, the physician would have to refuse such petitions. But even in refusing these requests or in withdrawing from service, respect for the person in question should not be abandoned.
Another consideration, recognized in every field of human experience as well as in medicine, is that people who engage in destructive behavior are not aided by damaging or vindictive remarks, Beating down another person, or belittling him, does not help in overcoming disvalued behavior, Drug abusers and alcoholics do not recover because someone continually berates them. Avoiding damaging remarks and behavior, however, does not mean that the health care professional will never discuss values or detrimental behavior with patients. Indeed, if values have such an important part to play in life, if they influence so much of our human behavior and well-being, they should be a factor present in medical diagnosis and prognosis. True, they will usually be in the background of the medical decision making process, but they are not to be eliminated as unimportant tant, In introducing any discussion of behavior or values with the patient, the health care professional should be guided by the values of medicine, respecting the patient as person.
Conclusion
The essence of medical care concentrates upon the particular, No two people are alike. Each encounter with a patient is a new adventure in mutual growth if the professional respects the dignity of the person who comes for help. In this sense, there is a beneficial meaning to the slogan, "Don't be judgmental."
Kevin O'Rourke. OP
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