Medical ethics: Does the public need to know why Austin was hospitalized?

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Following a days-long delay in the release of information about Defense Secretary Austin’s condition, NPR’s Michel Martin asks medical ethicist Keisha Ray about privacy rights of public officials.

MICHEL MARTIN, HOST:

The Biden administration says Defense Secretary Lloyd Austin’s job is not in jeopardy because he didn’t disclose a health condition requiring hospitalization sooner. But some critics, mainly Republicans, are calling for him to be fired. And others say the rules around disclosing this kind of thing just need to be more clear. Here’s former Defense Secretary Leon Panetta on CNN.

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LEON PANETTA: The health of the secretary of defense is a public issue. It’s a public matter.

MARTIN: So having talked about the politics of this, we wanted to think more about this from a different perspective, so we’ve called Keisha Ray. She is an associate professor at UTHealth Houston, where her focus is medical ethics. Good morning.

KEISHA RAY: Good morning.

MARTIN: So as a medical ethicist, how are you responding to this controversy? I mean, on the one hand, most people don’t want their personal business, you know, in the street. On the other hand, Secretary Austin’s availability to address crises is relevant, given his position. Should he have been more forthcoming?

RAY: Right. I think this issue, you have to really separate workplace ethics and workplace norms from the ethical standards of privacy because if you look at it from a medical ethics standpoint, we want to make sure that Secretary Austin, when he’s in the position of a patient, that he gets all of the benefits of patients. And that includes privacy, which particularly means control over his health information. And so you have to sort of separate what he should do as a secretary of defense, but then also what he should do as a patient.

MARTIN: Can I just ask you about this because we’ve been focusing on, you know, the obvious question of the United States is engaged in some – a number of very sensitive sort of foreign policy issues at the moment where his advice, presumably, is critical. On the other hand, do you see some drawbacks if public officials are required to disclose certain health information?

RAY: Absolutely. So, one, we are all just entitled to being able to hold on to our health information. That’s just something that is basic of medical ethics. But then, also, there are – there may be political or diplomatic reasons to keep health issues private – that they can be used against you, be used against the country, those kinds of issues. But ultimately, we want to make sure that people reveal their health status when they want to and not when they are forced to.

MARTIN: But what about that public – I don’t know if it’s the public here or whether it’s his – the people who are part of the national security leadership who are most relevant here. So let’s just for the sake of this just talk about that. I mean, isn’t there a level of disclosure that should be required within that circle? Or perhaps not. I don’t know.

RAY: Yeah. I think that’s just, again, going back to separating what is medically ethically required and workplace norms. Workplace norms may require you to reveal certain information for the sake of the job and to make sure that everything is in place and everything is being taken care of – all of the duties. And if you cannot perform your duties, then that’s when workplace ethics would come in and say, OK, let’s make sure that people know that you are temporarily unable to perform your duties. And so I just want to make sure that we’re separating those two. And if he is required to reveal his health information, then that’s a norm that needs to be established for all government officials in these high-level positions and not just one person. But we need a protocol.

MARTIN: This is not an excuse, but it may be an explanation. I am curious if you think – because your focus is medical ethics and you have done a lot of research into specific communities, do you think culture plays some role in this?

RAY: Absolutely. Whenever we’re talking about health issues, whenever we’re talking about privacy standards and confidentiality, we have to look at it with some sort of cultural competency, right? We have an older Black man. We have an older Black man from the South. And we do know medical ethics is that certain populations in our country do tend to be a bit more private and want to handle things on their own or within their close-knit family and friends. And so we can’t ignore that in the moment when Defense Secretary Austin – when he was a patient, he is still entitled to those benefits of a patient, and that means handling these issues private if he likes.

MARTIN: That is Keisha Ray. She’s an associate professor of humanities and ethics at UTHealth Houston. Professor Ray, thank you for joining us.

RAY: Thank you.

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