SHOULD DOCTORS TELL?
Of the many differing opinions concerning the question whether doctors should reveal medical secrets, none that I know have been more interesting, in particular to women, than that of a local practitioner (whose name I have forgotten) who spoke at a Conference of doctors met to consider this question. In opposing with admirable frankness a resolution for the continuance of the practice of professional secrecy, he asked the straight question, whether “a bounder” should be allowed to live and his wife and child to die?
For here we touch at once the grave difficulty of the position. The discussion, as is evident, was concerned more particularly with the position in regard to venereal diseases.
The whole question has, indeed, been brought before public attention in connection with the recommendation of the Royal Commission on Venereal Diseases that a communication made by a medical practitioner with regard to these diseases and to guard the innocent from infection should be regarded as a privileged communication, and the law of libel be so modified as to give this safeguard.
Now, on the face of it, this would seem a simple matter. And the question I want to ask is, why the professional medical voice of this country has pronounced so emphatically against it? I know, of course, the reason that is given, that the divulging of a patient’s secret, without his or her consent, and even if for a good reason, must weaken confidence—not only the patient’s confidence in the particular doctor who “told,” but the confidence of the public in the whole medical profession.
I do not think this reason bears any close investigation. Confidence is destroyed quite as surely, though probably not so quickly, by suppression of truth as by revealing it.
No, I believe we have to look deeper for the reason to explain this attitude of medical hiding.
These diseases are set apart from all other sicknesses of our bodies. For this reason, in considering them, moral considerations become confused with practical values. And I do not see quite how this is to be avoided. There is however, the gravest danger from such an attitude which rests upon hidden personal prejudices, and is not dependent on the facts of the case. Such an attitude leads inevitably to concealment of truth, which is specially disastrous here, because it is absolutely essential that these diseases, if they are to be cured, should be met in the open and grappled with methodically and thoroughly.
For greater clearness, I may state the matter thus: There are three attitudes that may be adopted towards sexual disease. First, that of the pure moralist, who says only “This is a sin to be punished.” On the opposite side is the purely utilitarian, who says, “This is only a disease to be cured.” But both attitudes may be alike wrong or, more correctly, the truth lies midway between the two. The disease, as a disease, needs to be cured. This is the first step with which nothing should interfere. But far different and much more complex is the treatment required to alter the actions that lead to the disease.
As a first step, public opinion ought to condemn too late marriage, instead of recommending it on economic grounds. The mania for making economics the deciding factor in conduct should surely cease: the falsity of this view has been exposed by many great writers, but much stronger is the condemnation that must be given here by all who can understand the evils that it has wrought in our sexual lives. Late marriages must be one of the causes contributing to men’s use of prostitutes before marriage.
We have to find a way out, to silence our shrieks of blame, and to give up many of our old pretences. You can never get things right until you honestly face them.
Women are the worst sinners. And I say, without hesitation, that it is men’s fear of women, especially the husband’s fear of his wife, that is the greatest hindrance to openness in this connection. It is women’s attitude which holds us back in progress towards health.
Let me give an illustration. I attended recently a meeting where a paper was read on the morals of men, in connection with the alarming increase of venereal diseases since the war. The reader of the paper, being a woman doctor as well as a feminist, took the wise view that the most urgent question was not the reform of the men, but staying the spread of the diseases. In the discussion that followed it was plainly evident that few of the audience—all women—agreed with her. These were women workers, who had read about, and to some limited extent, at any rate, thought and studied, these questions. Yet the general view was that men ought to be punished. One speaker, who stated that she was married, said that no true woman could or ought to forgive a husband who had become infected with a contagious disease.
Now, it is this view, here so crudely expressed, that has done so much harm in the past. It explains also the continuance of the medical secrecy that has acted so strongly against the stamping out of this scourge of civilisation. Such an attitude of blame and unforgiveness on the part of women has to be changed before the truth can be told safely.
Women are mainly responsible for the secrecy of these diseases. And what is the result? Because these infectious diseases are secret they are largely uncured.
It is, of course, easy to understand the attitude taken up by women. Blame of men is not easily avoided; yet is there not confusion in women’s minds?
The sin that a husband commits against his wife, a man against the girl he is to marry—yes, and a son against the trust of his mother—is in being unfaithful. Having caught the disease is a misfortune. The effect must not be blamed by itself.
Let me illustrate this point of view by considering a different case. Your child gets scarlet fever by an act of direct disobedience—the sin of his age. He stays from school, without leave of absence, and goes to play at a house he has been forbidden to enter. Would you, because of his disobedience, refuse to pity and nurse him? Rather, would you not forget his sin and desire only to help and heal him?
Do you see what I mean now? It is not that I would condone immoral conduct in the husband or the lover that I plead for pity and understanding on the part of women who love them.
Few men are intentionally evil. They do not even always act foolishly in this question of infectious diseases because they are wantonly careless. Often they are fully alive to the danger that may result to their wives, or the girl they wish to make their wife, from their own infection.
I repeat, they are not necessarily bad men, and they love their wives and children; but they are cowards. All men are cowards when it comes to facing the blame and misunderstanding of the woman they love.
If they cannot rely on the woman’s pity and help, few men will dare to tell the truth; nor will they be willing to let the doctor tell the facts for them. And if the truth cannot be told, it is very unlikely that the infection will not be spread to others. This may lead to the birth of diseased children, and who may say that in this case the crime is the man’s alone?
Why can’t we face the situation now, when we are trying to tidy up our social life? Concealments that may have been necessary in the old time of ignorance are surely impossible now.
Is the evil to remain hidden, uncorrected, from one generation to another? Hidden evil multiplies itself, and the sum is national deterioration.
The mistake has been the muddleheaded thinking that has obscured the plain and comparatively simple question of cure with the entirely opposed problem of moral appraisement and punishment: a confusion and losing of the way that has led us all inevitably into a forest-tangle of difficulty, of lies and silences, and unanswerable questions.
And this heritage of wrong thinking is still compassing our feet, binding them and throwing us down, as soon as we try to move a step onwards: and until that entanglement is broken through, by bringing the whole complicated position into the light of understanding and honest thinking, the evil will go on, unchecked by our futile tearings here and there at withered branches. The supporting stem of concealments and dishonesty will flourish, and the devastating evil will continue to spread.