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The Joe Rogan Experience (JRE) podcast was again the subject of controversy when a recent episode was criticized by scientific experts for spreading misinformation about COVID-19 vaccinations. It was not the first time this has happened: Rogan has frequently been on the hot seat for espousing views on COVID-19 that contradict the advice of scientific experts, and for entertaining guests who provided similar views. The most recent incident involved Dr. Robert Malone, who relied on his medical credentials to make views that have been widely rejected seem more reliable. Malone has himself recently been at the center of a few controversies: he was recently kicked off of YouTube and Twitter for violating their respective policies regarding the spread of misinformation, and his appearance on the JRE podcast has prompted some to call for Spotify (where the podcast is hosted) to employ a more rigorous misinformation policy.

While Malone made many dubious claims during his talk with Rogan – including that the public has been “hypnotized,” and that policies that have been enforced by governments are comparable to policies enforced during the Holocaust – there was a specific, ethical argument that perhaps passed under the radar. Malone made the case that it was, in fact, the moral duty of himself (and presumably other doctors and healthcare workers) to tell those considering the COVID-19 vaccine about a wide range of potential detrimental effects. For instance, in the podcast he stated:

So, you know my position all the way through this comes off of the platform of bioethics and the importance of informed consent, so my position is that people should have the freedom of choice particularly for their children… so I’ve tried really hard to make sure that people have access to the information about those risks and potential benefits, the true unfiltered academic papers and raw data, etc., … People like me that do clinical research for a living, we get drummed into our head bioethics on a regular basis, it’s obligatory training, and we have to be retrained all the time… because there’s a long history of physicians doing bad stuff.

Here, then, is an argument that someone like Malone may be making, and that you’ve potentially heard at some point over the past two years: Doctors and healthcare workers have a moral obligation to provide patients who are receiving any kind of health care with adequate information in order for them to make an informed decision. Failing to provide the full extent of information about possible side-effects of the COVID-19 vaccine represents a failure to provide the full extent of information needed for patients to make informed decisions. It is therefore morally impermissible to refrain from informing patients about the full extent of possible consequences of receiving the COVID-19 vaccine.

Is this a good argument? Let’s think about how it might work.

The first thing to consider is the notion of informed consent. The general idea is that providing patients with adequate information is required for them to have agency in their decisions: patients should understand the nature of a procedure and its potential risks so that the decision they make really is their decision. Withholding relevant information would thus constitute a failure to respect the agency of the patient.

The extent and nature of information that patients need to be informed of, however, is open for debate. Of course, there’s no obligation for doctors and healthcare workers to provide false or misleading information to patients: being adequately informed means receiving the best possible information at the doctor’s disposal. Many of the worries surrounding the advice given by Malone, and others like him, pertain to just this worry: the concerns that they have are overblown, or have been debunked, or are generally not accepted by the scientific community, and thus there is no obligation to provide information that falls under those categories to patients.

Regardless, one might still think that in order to have fully informed consent, one should be presented with the widest range of possible information, after which the patient can make up their own mind. Of course, Malone’s thinking is much closer to the realm of the conspiratorial – for example, he stated during his interview with Rogan that scientists manipulate data in order to appease drug companies, as well as his aforementioned claims to mass hypnosis. Even so, if these views are genuinely held by a healthcare practitioner, should they present them to their patients?

While informed consent is important, there is also debate about how fully informed, exactly, one ought to be, or can be. For instance, while an ideal situation would be one in which patients had a complete, comprehensive understanding of the nature of a relevant procedure, treatment, etc., there is reason to think that many patients fail to achieve that degree of understanding even after being informed. This isn’t really surprising: most patients aren’t doctors, and so will be at a disadvantage when it comes to having a complete medical understanding, especially if the issue is complex. A consequence, then, may be that patients who are not experts could end up in a worse position when it comes to understanding the nature of a medical procedure when presented with too much information, or else information that could lead them astray.

Malone’s charge that doctors are failing to adhere to their moral duties by not fully informing patients of a full range of all possible consequences of the COVID-19 vaccination therefore seems misplaced. While people may disagree about what constitutes relevant information, a failure to disclose all possible information is not a violation of a patient’s right to be informed.

In 2000, Albert W Wu introduced the term second-victim phenomenon to describe the emotional distress that physicians have when they make a medical error that results in harm for a patient. Since then, the term has been cited over 400 times in The Web of Science, and PubMed has over 100 titles with “second victim” in the title or abstract. The purpose of the term, as described by Wu, was to bring attention to the need of emotional support for doctors who are involved in a medical error. Since then, however, it has been debated whether that phrase is appropriate terminology given the severity of the implications.

Doctors and nurses experience an emotional rollercoaster everyday with high pressure jobs and people’s lives at hand. Mistakes in the field can have lethal, legal, and emotionally- distressing effects for the provider as well as the patients and families involved. Doctors have been under an increasing amount of pressure recently as well with the increasing amount of productivity requirements and increased required documentation. The nature of the job with the additional pressures leads to an increase of physician burnout.

Hospitals analyze mistakes made by physicians in a few different ways. They have Morbidity and Mortality conferences, critical incident debriefs, and even peer review systems. Hospitals aim to find the root cause of the problem. They want to identify any safety nets that were missed and find ways that mistakes can be prevented. However, these initiatives typically lack to touch on the emotional distress that the physician can feel after the accident.

One way that hospitals have attempted to incorporate a mental health support system for these cases is called Schwartz rounds, named after a healthcare attorney who died of lung cancer that was touched by simple acts of kindness he had in his last days of care. During a Schwartz round, a doctor talks about the care of patients in the hope of increased compassion and collaboration between physicians and patients. Dr. Elaine Cox, the Chief Medical Officer of Riley Children’s Health says, “The overwhelmingly positive response to such rounds underscores the desire for connection and support that all of our clinicians are thirsting to find. This type of intervention, and others that accomplish the same end, may be the most pressing need to support those who work in health care.” Unfortunately, there are very few resources that exist to further these initiatives.

There are dangers in not addressing the emotional traumas that professionals are left with after a medical mistake. Physicians can react in ways that are detrimental as a way to protect themselves. They respond to their own mistakes with anger, projection of blame, or by acting defensively and/or blaming the patient or other members of the healthcare team. Long-term ramifications for the emotional distress experienced by physicians can lead to burn out, substance abuse, or even suicide. On average, 400-700 physicians take their own lives per year. “Second victim” terminology was designed to draw attention to these serious consequences of medical mistakes that are so often overlooked.

However, at the root of medical professional’s job, is the oath of “do no harm.” Some believe that describing doctors as ‘victims’ diminishes the responsibility and accountability of the mistake. Calling physicians ‘victims’ seems to imply that the medical error was a random event, a piece of bad luck, or an unpreventable occurrence. It is reasonable for patients and their families to expect providers to be accountable for their actions. Physicians foremost have an ethical responsibility to tell their patients of an error, especially if the error has caused harm. This is to respect the patient’s autonomy, as they have the right to be told the logistics of their medical care.

Management of patient care is carried out by a combination of institutional systems and the professional actors within it, and healthcare professionals can be agents of harm, even if unintentional. The need for transparency is pressing. Without responsibility and accountability, the effectiveness of patient safety and care is undermined.

Patients represent the central focus of healthcare. While physician health is an important piece, referring to doctors who have committed medical errors as “second victims” obscures the difference between the two in terms of agency. The emotional distress suffered by physicians should be addressed, as it can affect their quality of care with their patients, but we might question whether referring to both patients and providers alike as “victims” is the best way to address the situation.