A Doctor’s Responsibility

by Danielle Ofri
New York Times op-ed

As a physician, do I or don’t I?

I‘m walking home from the subway with my 12-year-old daughter when we pass a man sitting on the sidewalk, head hanging down over his knees. Living in New York City, we see a lot of people, sadly, like this. Their numbers are increasing, as the surge of opiate addiction meets the surge in housing prices.

Everyone has to make a personal decision about if, when or how one should do something, or just walk on. If you’re a parent, there’s the additional challenge of navigating these heartbreaking dilemmas with your child. For doctors, it’s a little different. The American Medical Association code of ethics says that doctors have “an ethical obligation to provide care in cases of medical emergency.”

The problem is that emergencies are not always obvious: Is that gentleman on the bench overdosing or just dozing? And in the past, I’d always assumed that even if I did come across someone with an emergency medical problem, my intervention would likely be a moot point, because I wouldn’t have any medical tools with me, other than a phone for calling 911, like any other passer-by.

But this time is different. This time I have a naloxone kit in my bag, a nasal-spray version of the drug that can reverse an opiate overdose. This is the first time I am on the street with a potent medical intervention in hand. And now that I have it, I wonder what my responsibility should be.

The potential vastness of the situation gives me pause. I can’t possibly shake the shoulder and assess the vital signs of every seemingly sleeping person I pass on the street.

The bristly edge of pragmatism chafes, though. The very fact of there being so many in need doesn’t erase the moral duty to help any individual patient. I can’t shirk my duty to the man in front of me just because there might be another person on the next block, and two on the block after that. This is a lesson my generation learned during the AIDS epidemic. Our predecessors learned this with tuberculosis, smallpox, yellow fever and bubonic plague.

Moreover, I have a leg up on my clinical ancestors because an antidote — at least a temporary one — sits ready in my hand. A human being destined to die can be saved, if it is administered at the right time in the right circumstance.

I peer at the gentleman slumped over on the sidewalk. I debate if I should wake him up and check to see if his pupils are pinpoints. “Excuse me, sir,” I imagine the scenario playing out, “do you mind if I barge in on your life to see if I can save your life?” At what point does concern morph into presumption? The line between kindly interventions and condescending ones can be perilously thin.

But I don’t want to just walk by and ignore suffering. I don’t want to do this as a citizen, as a physician, or as a role model for the child at my side. I don’t want to inure her to pain. But I also don’t want her to get saturated with the nihilism that can descend once one begins contemplating the infinite needs of humanity.

I check the man’s breathing — it’s steady. There aren’t any drug paraphernalia around him. He stirs then, shuffling a book from his left hand to his right. I watch for a few more minutes and his respirations remain robust and regular. O.K., I conclude, the diagnosis appears to be sleep.

My daughter and I walk somberly the rest of the way home, talking of the adversity that many people in our city face. I recognize that pragmatism does play a role in moral decisions. If there were a thousand people dozing on the street, I’d never make it home. I would fail in my responsibility as a parent, as well as in my responsibility as a physician to all the patients who await in my clinic tomorrow. It’s not possible to treat everyone.

The naloxone is still in my bag, still unused. I’ve noticed that its mere presence, though, keeps me more on my toes. I walk by those on the street a little less blithely now, a little more attuned to respiratory rates. No individual can pave the road alone, that is true. But that shouldn’t stop us from carrying a cobblestone or two in our pockets. If we’re actively looking, we’ll find the right spots to place them.