IX. On Physicians, Surgeons, and Pharmacists

What are the obligations of physicians, surgeons, and pharmacists? - Physicians and surgeons are bound: Under grave obligation to have sufficient knowledge, so that they know how to prescribe suitable remedies for ordinary illnesses, and at least to doubt concerning other extraordinary diseases, so that a more skilled physician can be called. To apply diligence proportioned to the gravity of the matter which is committed to their care. To preserve fidelity, lest they reveal the secrets committed to their trust and abuse them; but if they fail in these things, they are held for all damages which follow from this. To preserve a just stipend, which is owed to them, as was said concerning advocates. To provide their labor gratuitously to the poor who are in necessity, as was also said concerning advocates. Cf. 40. In applying remedies they must observe the following rules:

They must altogether abstain from prescribing any medicine which directly and of itself is ordered only to evil. Cf. La-Croix, l. 6, p. 3, n. 795, 796. Ordinarily they must follow the safe and secure opinions of physicians. The reason is the danger and damage of the neighbor. When there is some certain medicine, namely one which certainly is going to benefit the sick, they are bound to apply it, omitting that concerning which there is doubt, because otherwise they would imprudently leave the neighbor in danger. If there are no certain medicines, they must apply the more probable and safer ones, both because otherwise they would bring the health of the neighbor into danger, and because they are bound to discharge their office, as much as they can, with the least danger and damage to the neighbor. If it is probable that a remedy will be beneficial, then they can, indeed they are bound, to apply it when they do not have a more certain one. If a remedy is doubtfully going to be beneficial, and certainly will not harm, it must altogether be applied to the sick person. The reason is clear: for some hope shines forth of rescuing the sick person from death, and no danger threatens. When the health of the sick person is despaired of, and both things are probable, namely that the remedy could benefit and could harm, there is a twofold probable opinion. The first denies that it can be applied, because it is never lawful to expose a sick person to the danger of death, nor even of hastening it. The other affirms that it is lawful, because, when the sick person is despaired of, it is more conformable to prudence and to the will of the sick person (especially if he himself expressly consents to this) to apply to him a doubtful remedy than to omit it with certainty of death. The remedy then has at least this good effect: for it now renders doubtful the certain death of the sick person.

Therefore it cannot be called evil. Tamburini has these things as regards this question: "Both opinions are probable, and from the affirmative it follows that the physician ought to apply it, because since he can, he also ought to consult for the one lying sick by every better way." Expl. decal. l. 1, cap. 3, par. IV, n. 17. When the health of the sick person is despaired of; for outside the case of a despaired-of sick person, it is not to be offered, but one must wait for nature, with God's help, to lift itself up. S. Antoninus p. 3, tit. 7, cap. 2. It is not lawful to apply to a sick person, even a despaired-of one, a remedy concerning which it is unknown whether it is healthful or harmful, for making an experiment. The reason is that it is altogether unlawful to make an experiment with the risk of another's life. L. 291; l. 1, n. 46.

Pharmacists are held to the same obligations as physicians, with due proportion. Especially, however, they are held to supply exactly the medicines prescribed by the physician. Nor can they, if they themselves do not have the prescribed medicine, substitute another.

Does a physician sin gravely who in a time of plague deserts the sick lest he contract the infection? - Reply: Negatively, speaking in itself, if the physician has not been constituted by the community, nor receives any stipend from it; for then he is held only from charity, which certainly does not oblige with grave risk of life. Speaking in itself; for if there were no other physicians, or those who are present do not suffice, he would be bound from charity itself to consult for the common danger altogether. Affirmatively, if the physician has been constituted by the community and receives a stipend from it. The reason is that then from the pact entered into, and therefore from justice, he is bound to consult for the common danger.

To what is the physician especially held as regards the soul of the sick person whose care he has undertaken? - The physician is bound in itself under grave obligation to warn the sick person concerning the grave danger in which he is placed, and concerning the necessity of receiving the sacraments, lest he depart without absolution, Viaticum, and extreme unction. This is established from the natural law of charity. It is sufficient, however, that he take care that the sick person be warned by relatives or friends, so that he may kindly admit the priest and be induced to receive the sacraments. This warning is also necessary so that the sick person may dispose concerning his affairs, if he has not already done this before, lest damage then follow. L. l. 3, n. 182.

Note: There is a precept in this matter of Innocent III, C. Cum Infirmitas 13 de Poenit. et remiss., and of S. Pius V, C. Super gregem, March 8, 1566, at least in part abrogated by contrary custom. Physicians of bodies, before all things, had to warn and induce the sick person to call physicians of souls; and after provision had been made for the sick person concerning spiritual health, one would proceed to the remedy of bodily medicine. Physicians to be promoted to the doctorate had to swear that they would warn the sick, laboring under grave disease, concerning confession before they undertook their care, and that they would no longer visit them if within three days they had not confessed. L. l. 3, n. 182; Prax. conf. n. 57; Ithur. Cas. 49, n. 8, 9.

You will resolve: A physician sins gravely: If without sufficient capacity he undertakes to cure a grave disease. If, when a grave and unusual disease occurs, he does not devote special labor. If he applies untried medicines for the sake of trying them. If, when the nature of the disease has not been well ascertained, he rashly prescribes dangerous remedies, especially with risk of life or grave injury. If, once the danger of the sick person has been recognized, he is not present at the opportune time, visiting him day and night if need be, and does not apply all remedies apt for driving away the disease. If he does not permit other physicians to be called where this would be fitting, or if, calling others for the sake of counsel, he attends rather to friendship than to skill. If, on the contrary, without necessity he calls other physicians, with useless expenses for the sick person, or adheres against his own conscience to their counsels. If he prolongs the cure for the sake of gain, uselessly multiplies visits where a fee is demanded for each one, or if he demands an excessive stipend. If, to favor pharmacists who are friends, he prescribes superfluous medicines. If he advises abortion, or means of procuring it, or himself executes it. Finally a physician sins gravely, indeed most gravely, if he does not forewarn concerning the grave danger of the sick person, so that the sacraments may be conferred on him. L. 291 and l. 3, n. 182.

Pharmacists, if you except a few things, sin almost as physicians do in the cases just set forth, especially by applying old medicines, selling useless ones, supplying pregnant girls with remedies for expelling the fetus, not faithfully executing the commands of the physician, for example by presenting one medicine for another, etc. L. ib.