Should Politicians Pledge to Do No Harm?

Beneficence.  Nonmaleficence.  I’m wearing my bioethicist hat as I write today.  When thinking about health care, ethicists focus on several widely-accepted principles of medical ethics.  Two of the most basic principles doctors, nurses and other health care providers strive to honor are to do good for their patients (beneficence) and to do no harm (nonmaleficence).

Sometimes I can’t help but wonder whether our elected officials, and even those would-be leaders newly embarked on the campaign trail, should be required to pledge an oath to do no harm, just as many hard-working health care providers are asked to do.  If we could prod our leaders further to that next step, to actually do some good, that would be icing on the cake.

The average American knows our country is in a mess and that we have some tough choices ahead.  We don’t really expect any one elected man or woman to fix all our problems.  As a people, however, most of us still believe these problems can be solved if we work together. 

We are a caring, principled, energetic, intelligent, generous and resourceful nation.  We want our leaders to represent the best of those qualities as they plan for our future and work for our present.  Being a congressperson, senator or president is a job, not a right.  It is a hired position for which one receives a salary, power and privilege to enable him or her to SERVE the people.  That idea seems to have gotten a bit lost in Washington.  Too often these days, our government seems to hurt us as much as it helps.

Let me provide a recent concerning example from the campaign trail that led me to suggest the need for a “do no harm” oath for all candidates and elected officials.

Rep. Michele Bachmann, a current member of the House of Representatives and a Republican candidate for president, has been attacking one of her opponents, Rick Perry, Governor of the great state of Texas, for his 2007 order that required young girls in Texas (approx 11-12-year-olds) to receive the vaccine Gardasil that protects girls against HPV, human papillomavirus, which can cause cervical cancer in women.  Under Governor Perry’s Executive Order, parents were permitted to “opt out” and not vaccinate their children.  Gov. Perry said he wanted to prevent cancer and save lives.

The citizens and legislature of Texas had some issues with the fact that the Gardasil decision had not come through the legislature, but instead directly from the governor’s office, and there were some conflict of interest allegations about the Perry camp and the vaccine manufacturer; the Texas legislature eventually overturned this particular vaccine requirement.   

Opponents of the vaccine claimed that the requirement for vaccination presumed that these girls would engage in sexual behaviors over the years from which they could contract HPV – some opponents portrayed the requirement as a governmental assumption of future immoral conduct by their daughters (in reality, diseases rarely limit their transmission to only immoral human conduct, but not all arguments are created equal).  There were other arguments about individual liberty, the privacy of the body, the impropriety of the state’s involvement in any health care choices, etc.  Regardless of the Texas legislature’s action, in the ensuing years, millions of young women around the country have voluntarily been vaccinated, including many in Texas.

Rep. Bachman, in her apparent eagerness to question Gov. Perry’s judgment in the Gardasil incident, gave interviews in the last couple of weeks in which she stated that a mother had approached her and told her that the HPV vaccine had caused the mother’s daughter to become mentally retarded.   Wow -- that was a sound bite sure to get parents’ attention!   Rep. Bachmann provided this information on news shows, shows she hoped would be broadcast to millions of people.  Did she request medical records and have an expert examine them?  Did she fact check any of this?  

Does the claim even make sense?  We generally think of mental retardation as causing developmental delays, a failure of cognitive skills and related physical abilities to develop on schedule.  If the vaccine is not administered until around the onset of puberty, many of these developmental cognitive and physical milestones have already been achieved.  Instead of development being “retarded”, did the young girl in question allegedly regress?  What was the mother’s actual claim?

Dr. O. Marion Burton, president of the American Academy of Pediatrics, a national organization of U.S. pediatricians, stated in response to Rep. Bachmann’s interviews:

“The American Academy of Pediatrics would like to correct false statements made in the Republican presidential campaign that HPV vaccine is dangerous and can cause mental retardation.  There is absolutely no scientific validity to this statement.  Since the vaccine has been introduced, more than 35 million doses have been administered, and it has an excellent safety record.

The American Academy of Pediatrics, the Centers for Disease Control and Prevention, and the American Academy of Family Physicians all recommend that girls receive HPV vaccine around age 11 or 12. That’s because this is the age at which the vaccine produces the best immune response in the body, and because it’s important to protect girls well before the onset of sexual activity.   In the U.S., about 6 million people, including teens, become infected with HPV each year, and 4,000 women die from cervical cancer. This is a life-saving vaccine that can protect girls from cervical cancer.”

See http://www.aap.org/advocacy/releases/hpv2011.pdf. 

So what did parents likely hear in all this?  Congresswoman Bachmann said that HPV vaccine causes mental retardation.  That’s the sound bite playing over and over.  Will all those alarmed parents read the American Academy of Pediatrics’ aggressive denouncement of Rep. Bachmann’s remarks?  No.  The result is that some families will choose not to vaccinate their daughters against HPV, increasing the children’s risk for developing HPV and cervical cancer later in life.  Rational scientific voices never get as much press as do fear-mongering threats. 

Even today, many families do not provide standard immunizations to their young children because one doctor, many years ago, linked those immunizations to possible autism.  His research and claims have been reviewed and refuted, that doctor actually lost his medical license, and repeated studies have shown no link between childhood vaccines and autism.  And still some parents do not vaccinate.  Childhood diseases that had been all but eradicated, such as measles, are on the upswing and are again causing serious illness and even death.

Rep. Bachmann tried to defend herself and her statements on a subsequent radio show by saying she was not a doctor, scientist or physician.  If not, then why was she reporting on national news an unverified claim that she knew would frighten many families away from the HPV vaccine?  Was it a reckless error, an irresistible chance for one more dig at an opponent, or an opportunity for national attention she simply couldn’t pass up? 

Her motivation really doesn’t matter.  The result does.  The goal of our leaders should be to do good and, if they can’t manage that, at the very least to do no harm.  Rep. Bachmann failed on both counts.

During this campaign season and beyond, let’s hold our candidates and elected officials to the same principle we expect to be honored by our doctors:  First, do no harm.

DeLila Bergan, JD, MA

E-Senior Services/AIM Mediation

P.S.  So what oath do Congressmen and Senators take?

“I do solemnly swear (or affirm) that I will support and defend the Constitution of the United States against all enemies, foreign and domestic; that I will bear true faith and allegiance to the same; that I take this obligation freely, without any mental reservation or purpose of evasion; and that I will well and faithfully discharge the duties of the office on which I am about to enter:  So help me God.”

It’s a good oath, but there is room in there to add “and I will do no harm to the people whom I serve.”  Let’s try it.