Wednesday, July 13, 2011

What are our moral obligations?

The cost of my college education exceeded $100,000.  I have a Master's degree, a brain that functions perfectly well, the ability to collaborate with others at a high level, and the desire to make the world safer, smarter, better, more just.  But here's what I did yesterday:

I woke up to baby Caroline, fed her, packed Molly's suitcase for her trip to Ohio, sat on the floor and intermittently played with Caroline and watched her play on her own, fed Caroline a few more times, went for a walk, went to the grocery store, read some books (adult books, to myself), cooked dinner, fed Caroline again, put her to bed, did some actual for-pay work, watched tv, went to bed.

It's not an atypical day.  Usually, there's a little more going on, but with Molly gone, the day is a little duller.

But here's my question: spending days like this--days at home in the monotony of young childcare--is it a waste of my time?  Even worse, am I eschewing some higher or more pressing moral obligations by choosing to be the primary caregiver for my children?  Especially in light of the education and skills that I have, am I morally obligated to do something different with my days?

This is the fascinating and challenging debate that I (and countless others on both sides of the issue) have on a daily basis (if only in my own mind), and which I was completely engaged in this morning when I listened to an episode of OnPoint with Tom Ashbrook on NPR.  You can listen to the broadcast here.

This is the basic premise of the debate: Dr. Karen Sibert recently wrote an article saying that doctors (and, often, women doctors) are beginning to see part time work as an appealing and perfectly acceptable option.   Young mothers, especially, take advantage of this option when they begin having children, and it is typically soon after they finish their residency--so at the beginning of their medical careers.  The problem with this part time option is a complex one.  As Dr. Sibert points out, there is a current and projected shortage of clinical physicians, especially in the primary care field.  You would think that the solution to this would be easy--train more doctors.  However, there is not money in medical schools or, more importantly, residency sites, to enlarge the capacity.  Therefore, when a student decides to become a doctor, he or she is taking a precious spot.  Dr. Sibert believes that the commitment to medical school and further medical training is actually a moral decision.  In her argument, medical students are in essence placing themselves under obligation to their patients' lives and to the life-saving ability of the medical profession as a whole.  However, by determining that they will only practice part time, many physicians are actually taking up a spot that could have been given to someone who would have practiced full time, thus filling a gap in the system's ability to function more adequately.

Her argument, more succinctly: Doctors who receive full medical training but practice part time leave holes in patient care and risk patients' lives.   These doctors have a moral obligation to re-examine their commitments and realize that their patients' lives are of higher priority than anything else.  She also adds that we, as a society, have an obligation to inform students prior to entering medical school that these are their forthcoming obligations.

I sincerely hope that that this summary is not an unfair communication of Dr. Sibert's point.  I really want to illustrate her argument clearly, because I do think that it is worthwhile.  I like how she avoids focusing on individual doctors and is instead looking at the issue on a big picture level.  She is right that there is a problem with the level of care available, and she foresees that the problem will worsen if part-time medicine continues to be a widely available option.

The debate on OnPoint largely focused on female doctors, and particularly mothers.  Obviously, mothers are taking advantage of the part time option in large numbers because they want the extra time to spend with their children.  Several part-time, female doctors who were mothers contributed to the arguments in the broadcast.  They all talked about how much they valued being both a doctor and a mother, about how they had struck a work-life balance, etc.  However, I was very surprised that in the hour long conversation, people who took the opposite point of view from Dr. Sibert never countered her argument with a sense of moral obligation to the family.  Dr. Sibert kept talking about this moral obligation to the patient's life, but it's like it never occurred to anyone that women might have an obligation to their family, to raising their children.

Now, let me make it very clear that I do not think that every woman should stay home with her children as the primary caregiver.  I think that this is a wildly personal decision, and one that weighs heavily no matter what is decided.   A majority of women don't even have a choice--they can either put food on the table with a full time job or stay home and starve with their children.  We are lucky that we even get to have this debate.  However,  I am perplexed that there was not even a hint of the family as a moral obligation.

Is this a sign of the times, or am I just reading way too much into this?  Have we gotten to the point where our careers take precedence over our families?  I know that in terms of actual hours spent, we were there long ago.  But we keep believing that even if our hours are spent on our careers, at least our hearts and our minds are with our families.   At least we save our most precious selves for them. They are our highest priority.  But if we as a society are going to say that doctors have an obligation to their patients first, above other things, what else does it say but that the family is less important?

I like to think that the job I hold at this moment is as important as a doctor who is in an operating room saving a life.  My job surely has to be considered a long-term task--one that will see results in 20 years if I put in the steady, daily work of raising a child.  But if we are going to say that saving patient lives is truly more important, of higher moral value, then what am I doing?  I am living a wasted life.  I am taking my mind, my education, my potential and trading it for something less important.

I hope that we don't really believe that.

More thoughts to come...


Sarah said...

I'm still working on my actual comment on this post.

In the meantime, here are some thoughts from one of my favorite bloggers:

Karen said...

You know the saying, "The hand that rocks the cradle is the hand that rules the world."

If this is the case, then our obligation to society is, at least greatly in part, an obligation to invest in our children.

Each mother needs to decide what is best for her family. This may be to work full time, part time, or to stay at home. Sometimes, choosing to serve our country or others is the right option. Consider the soldier who fights for his country. His family most likely suffers in his absence, but they benefit in the long run. The decision is between an individual and God.

I agree with you that we are in danger when we view our morality in terms of doing solely what is best for our society.

Further, in spending more time with their children, I believe mothers will become better doctors. I know this is true for me; my immersion into motherhood has exponentially helped my ability to teach. Eliminate the freedom to work part time, and I imagine the medical field will lose many potentially terrific doctors.

I didn't hear the radio talk...perhaps this was addressed:

Are the universities clearly stating to future premed students that the expectation is for them to work full time in order to fulfill the need for medical personnel?

Kristin said...

No, universities are not expressing this to students. However, Dr. Sibert thinks that this is one of the major changes that needs to be made. She thinks that it needs to be clear that the expectation is a full time one. However, I don't think a 22 year old can have any idea of 1) what his/her immediate or distant future includes in terms of family life and 2) what impact his or her career commitment will have on that family life. That almost seems like an unreasonable thing to ask someone to commit to.

You have a really good point about the soldier. I think that I agree that, sometimes, there are sacrifices we make in our family lives for things like our country and even our careers. The thing that really concerned me about the medical discussion is that Dr. Sibert sees the moral obligation as being a very long term one. So it's not just for a few years. As far as I can tell, it's for the span of a whole career, which is the majority of one's life.

Thanks so much for the comments!