Duty calls

Diane Kelsall

Doing His Duty

—Inscription on tomb of solder killed in World War II (Mount Pleasant Cemetery, Toronto, Ont)

Duty—what an unfashionable word these days. We tend to hear far more today about rights than responsibilities. The word duty sounds unpleasant and demanding, as though we are being told to do something that no onewants todo. Inmedical practice, we often hear about duty when we have done something wrong. We read about it in written judgments when physicians have been accused of malpractice. The word duty is usually connected with failure.

Duty didn’t always have such negative connotations. At one time, the word symbolized all that was good in society. If each of us did our duty, society would be peaceful and prosperous. As the Battle of Trafalgar was about to start in 1805, Nelson had a signal flashed from his ship to the British fleet, “England expects that every man will do his duty.” And every man did.

In this issue, we look at duty in the context of the care of patients with obesity. Caulfield ( page 1129) argues that there are legal duties in the care of these patients by physicians. These duties include providing a reasonable standard of care, providing adequate information to obtain informed consent, and fiduciary obligations that arise out of the relationship of trust and confidence between doctor and patient. Caulfield emphasizes that understanding these duties is part of a risk-management strategy for family physicians—reducing the risk of being involved in a malpractice action. Again, a negative connection with duty.

Is there a positive side to duty in 2007? In our last issue (June 2007), we focused on death duties: the responsibility of family physicians to participate in the administrative tasks around their patients’ deaths. But with that responsibility comes a wonderful opportunity—the chance to be involved with our patients’ families at crucial times in their lives. To support, to encourage, and to console.

What about the care of patients with obesity? Is there a positive side to duty in this situation? Caulfield contends that there is. By understanding the ramifications of our responsibilities to these patients, we can offer better care. The principle of informed consent means that we are required to tell our obese patients that they have weight problems. We are required to inform them about the consequences of obesity, as well as the risks and benefits of treatment available. In the case of obesity, our duty gives us the freedom to be frank with our patients—thus opening the door to a potentially meaningful engagement with them on a tough issue.