Chapter V. On the Obligations of Physicians

I say 1st. Physicians are bound before all things under grave sin to have sufficient knowledge and skill, and to employ diligence proportioned to the gravity of the matter which is committed to their care. But if they fail in these things, they are bound for all damages which follow from it. Besides, they ought to furnish their work gratuitously to the poor who are in necessity, as was said above concerning advocates.

I say 2nd. But in curing the sick they ought to observe the following rules: 1st. they are bound to follow the secure and safe opinions of physicians, at least ordinarily, because danger to the sick person cannot be removed by probability; 2nd. when it is certain that some medicine will benefit the sick, they are bound to apply it, with the doubtful one omitted; but if the certain is lacking, they ought to prefer the more probable one. Hence:

A physician sins gravely: 1st. if without sufficient capacity he undertakes to cure a grave disease; 2nd. if, when a grave and unusual disease occurs, he does not spend special work; 3rd. if he applies untested medicines for the sake of testing; 4th. if, without the nature of the disease well examined, he rashly prescribes dangerous remedies, especially with risk of life or grave injury; 5th. if, when danger has been recognized, he is not present opportunely, visiting the sick person day and night if there is need, and does not apply all means suitable for driving away the disease; 6th. if he does not permit other physicians to be called, where this would be proper, or if, calling others for the sake of consultation, he attends to friendship rather than to skill; 7th. if, on the contrary, without necessity he calls other physicians with useless expenses to the sick person, or if against his own conscience he adheres to their counsels; 8th. if he prolongs treatment for the sake of profit, uselessly multiplies visits where a salary is exacted for each one, or if he exacts too great a price; 9th. if, in order to favor apothecary friends, he prescribes superfluous medicines; 10th. if he counsels abortion, or means of procuring it, or himself carries it out; 11th. if he counsels vasectomy to a man unwilling to have offspring; 12th. or rashly employs a means which can render a woman sterile. - Cf. St. Alphonsus, n. 291; on the second precept of the Decalogue, n. 182; and on the Sacrament of Penance, n. 664.

Where the sick person is despaired of, a remedy probably going to benefit must be applied if he has no other certain one; if the remedy is certainly not going to harm and doubtfully going to benefit, it must wholly be applied; in a positive doubt whether the remedy is going to benefit or to harm, outside the case of a sick person despaired of, it is not to be furnished, but the sick person is to be left to nature.

A physician is bound to the secret of office, which can never be violated except when a dominant reason exists. Hence it is not licit for a physician to manifest the diseases of a family or individual to an agent of an insurance company without their consent; nor is it licit for him to tell a man, without the woman's consent, of an operation, suppose ovariotomy, performed by him on the woman before marriage; nor to make known to a bride before marriage the ordinary diseases of the man which induce no danger of contagion. But if the man previously labored under syphilis, yet now is wholly cured, the physician cannot reveal that previous condition to the woman. But if his condition from that disease is such that he truly ought not now enter the conjugal covenant, let him gravely warn the man concerning his obligation of deferring the celebration, and let him threaten the grave difficulties that will arise from the nuptials. Finally, if the man refuses, the physician has of itself a right to reveal the matter. Yet he will easily be excused if the circumstances are such that he himself would lose the trust of the people from it. Nevertheless, often there can be circumstances which prove that an obligation is present, for example, the law of the place or the custom of physicians; for then there will scarcely be an excusing cause from the burden of protecting the woman, when this can be done without grave inconvenience. - Cf. Bulot, n. 460, 3. - Lehmkuhl, n. 1444. - Genicot, n. 432.

Just as a physician, so also a surgeon is bound under grave sin to have sufficient knowledge, skill, and dexterity. Regularly he cannot perform any operation without the prior consent of the sick or of those under whose care they are. Since the matter being treated is one which is under the absolute dominion of God and not of man, there is not permitted to him an operation whose expressly intended end is to render men sterile. - Cf. above, n. 264, Q. 5.

Question. To what is a physician specially bound with regard to the soul of the sick person whose care he has undertaken?

Resp. He is bound of himself under grave sin to warn him, prudently however, concerning the grave danger in which he is placed, and concerning the necessity of receiving the sacraments. This is established 1st. from natural law or from the precept of charity; 2nd. from the very well known Decretal issued by Innocent III in the general Lateran Council, year 1245, cap. Cum infirmitas, 13 de Paenit. et remiss., and confirmed and renewed by other subsequent Pontiffs, especially by St. Pius V in the Motu Proprio Super gregem, year 1566.