ACADEMIA Letters
Ethical drawbacks of treating doctors as heroes during the
COVID pandemic
Carlo Bellieni, Bioethics Committee of the University Hospital of Siena - Italy,
Bioethics Committee the Region of Tuscany - Italy
Medical doctors and nurses have serious reasons of worrying, and this wave of glorification as
heroes of the COVID pandemic, instead of helping them, risks of overshadowing their problems. Until a few months ago, the medical news on the media were full of reports showing
episodes of violence on the rise against doctors and nurses (1). The newspapers used to talk
of medicine in cases of edge-cutting breakthroughs of course, but mainly in cases of misconduct or medical errors. After the coronavirus outbreak, we only read of medical doctors as
healthcare heroes (2). This is the latest step of a negative path.
1. From demigods to employees
In the ancient past, doctors were something like “demigods” to the public: they knew how to
heal what was considered deadly, nefarious, and their actions were cloaked in mystery. Then,
the fall: in the last century the growth of technology and the fall of medical paternalism has
removed the aura of sacredness from medicine and the doctors have been normalized, but
with a worrying excess. They should be something more than mere dispensers of therapies
and drugs, but in pratics they are now employees and routine workers too often. And for them,
as for any other worker, the law of the market now applies.
Academia Letters, August 2021
©2021 by the author — Open Access — Distributed under CC BY 4.0
Corresponding Author: Carlo Bellieni, cvbellieni@gmail.com
Citation: Bellieni, C. (2021). Ethical drawbacks of treating doctors as heroes during the COVID pandemic.
Academia Letters, Article 2700. https://doi.org/10.20935/AL2700.
1
2. The corporatisation
Having reduced hospitals to companies (3) the budget becomes the main purpose and motivation, but what is included in the concept of a company is the concept of employee; and the
concept of employee conveys the idea of someone who does a repetitive job, prone to protocols, happy to be freed from worries because protocols propose the diagnostic and therapeutic
tools that make the risk of deciding superfluous, if applied as an acritical routine.
And above all, often doctors are not encouraged to do the extra mile off their duty, to
give an extra minute, to take care of the extra patient. This isn’t only the case for the work in
hospitals, but also for private practices, because in both cases the supreme rule of the doctorpatient relationship is the contract. The contract-based-medicine implies that you mustn’t do
anything less than what is written in the contract; but you should neither do anything more.
It’s a contract between an operator and a customer; once it was an alliance between a doctor
and a patient. But this generates dissatisfaction, and in the worst cases intolerance, complaints
and even physical violence if the contract doesn’t lead to the promised healing. Because the
contract promises recovery, or at least provides for it.
This is the nemesis, the revenge of the history that the Austrian philosopher Ivan Illich
described in his book “Medical Nemesis” (1976). He explained that medicine has been reduced to a series of protocols to apply to a series of determined situations, refusing a holistic
vision and preferring a medicine based on the cure of symptoms. Doctors have put too much
of their duty in the hands of lab results, and this has plugged their attention on the patient.
They thought to get more freedom, but they got more risks: no protocol and no test will guarantee the success, while most of medical activity is made of the time spent watching, talking,
examining, reflecting. This is one of the main causes of doctors’ dissatisfaction.
3. Everyday heroes
This routinary and disenchanted way of being doctors is common; the COVID pandemic has
pointed out that exceptions exist. But these exceptions are not limited to this episode. Warzones doctors have been heroes for centuries; as well as those doctors who everyday make
the extra mile to cure people at their own risk (4). But this kind of common heroism usually
benefits the poor people or poor countries and is therefore utterly neglected. Coronavirus, on
the converse, is also a high-income-countries disease, and for this reason has a preferential
track in vaccine making (who has ever seen that speed in vaccines for tuberculosis or zika of
malaria?). Are medical doctors being described as heroes in Western mass media, because
they’re treating a pathology that affects -among others - privileged countries?
Academia Letters, August 2021
©2021 by the author — Open Access — Distributed under CC BY 4.0
Corresponding Author: Carlo Bellieni, cvbellieni@gmail.com
Citation: Bellieni, C. (2021). Ethical drawbacks of treating doctors as heroes during the COVID pandemic.
Academia Letters, Article 2700. https://doi.org/10.20935/AL2700.
2
4. Reasons and risks of being treated as heroes
“Unfortunate is the country that needs heroes” Berthold Brecht wrote in his masterpiece “Life
of Galileo” (1938). Brecht did not want to make fun of the heroes, but pitied those who needed
them, because this need emerges when people live a lonely and routinary life. Three are the
main reasons for this sudden acknowledgement of doctors’ heroism. We have reminded above
that without the spread on rich countries of the COVID, all this interest in doctors’ activity
would not happen. Another reason is the general feeling of fear and loneliness expressed by
the population, that in similar times has always looked for a sort of supermen or superwomen
to save them. Moreover, the presence of superheroes is a fine opportunity for politics makers
to obtain two goals: misdirection and passage of responsibilities and duties (5).
An ethical approach to the phenomenon of medical glorification during the COVID pandemic needs to reckon doctors’ problems in everyday duties, and in particular in difficult
situations, difficult choices, hard relationships. An ethical approach should reckon that medical doctors risk to become employees, while they want more gratification and motivation; they
risk burnout, the rate of medical suicides is dramatically high. Medical COVID heroization
overshadows all this hard everyday scenario and draws health professionals as overaltruistic
and overstrong people, without specific and deep needs. Doctors and nurses are not happy for
this “heroization”, because this misdirects from the main focus: what doctors really want and
need. Otherwise, this will be nothing more than a soap bubble. Most doctors and nurses are
dissatisfied (6) and tired of uselessly asking for a better health system, many are disappointed;
in Italy, for instance, almost 3000 doctors a year abandon the public health system. (7) and
this problem of massive attrition is present in most countries (8). Being treated as heroes does
not change this scenario: we should ethically decide of redraw the image of medical doctors
on mass media and in public opinion, by pointing out how heroic but how tired most doctors
are.
Doctors’ glorification will soon disappear, but doctors’ problems won’t, as it overshadows
the real problems of this category. This glorification will be a soap bubble (9) if those who
want to be gratified by their work continue to be considered only “employees”, or engaged
with their patients not by trust but by contract. The healthcare system often does not give
motivation and respect, it is often based only on much bureaucracy, protocols and contracts..
True reasons to heal people in the most entusiastic way are needed; current routine and isolated
heroisations and can only get dissatisfaction.
Academia Letters, August 2021
©2021 by the author — Open Access — Distributed under CC BY 4.0
Corresponding Author: Carlo Bellieni, cvbellieni@gmail.com
Citation: Bellieni, C. (2021). Ethical drawbacks of treating doctors as heroes during the COVID pandemic.
Academia Letters, Article 2700. https://doi.org/10.20935/AL2700.
3
REFERENCES
1. Ahmed F, Khizar Memon M, Memon S. Violence against doctors, a serious concern for
healthcare organizations to ponder about. Ann Med Surg (Lond). 2017 Nov 15;25:3-5.
doi: 10.1016/j.amsu.2017.11.003. PMID: 29255603; PMCID: PMC5725205.
2. Bauchner H, Easley TJ; entire editorial and publishing staff of JAMA and the JAMA
Network. Health Care Heroes of the COVID-19 Pandemic. JAMA. 2020 May 26;323(20):2021.
doi: 10.1001/jama.2020.6197. PMID: 32310289.
3. Bellieni CV. Consumerism: a threat to health? J R Soc Med. 2018 Apr;111(4):112.
doi: 10.1177/0141076818763332. Epub 2018 Mar 1. PMID: 29493346; PMCID:
PMC5900838.
4. Branch J, Calero EK, Mann P, Jones LD, Erwin D, Wright JM, Said S. Where the heroes
are: testing in a war zone. MLO Med Lab Obs. 2008 Jul;40(7):30, 32-4, 36. PMID:
18717499.
5. Farjam M, Bianchi F, Squazzoni F, Bravo G. Dangerous liaisons: an online experiment on the role of scientific experts and politicians in ensuring public support for antiCOVID measures. R Soc Open Sci. 2021 Mar 10;8(3):201310. doi: 10.1098/rsos.201310.
PMID: 33959315; PMCID: PMC8074882.
6. Smith R. Why are doctors so unhappy? There are probably many causes, some of them
deep. BMJ. 2001 May 5;322(7294):1073-4. doi: 10.1136/bmj.322.7294.1073. PMID:
11337419; PMCID: PMC1120219.
7. Rivetti C et al: [Ospedali. “Oltre 3.000 medici nel 2019 li hanno abbandonati per
passare nel privato o sul territorio”. Lo studio dell’Anaao Assomed] Italian text. http://
www.quotidianosanita.it/studi-e-analisi/articolo.php?articolo_id=95447
8. Castro Lopes S, Guerra-Arias M, Buchan J, Pozo-Martin F, Nove A. A rapid review
of the rate of attrition from the health workforce. Hum Resour Health. 2017 Mar
1;15(1):21. doi: 10.1186/s12960-017-0195-2. PMID: 28249619; PMCID: PMC5333422.
9. Drummond D: Stop Calling Doctors Heroes and Saints: The Case Against Altruism.
Medscape Pediatrics November 2020 available at: https://www.medscape.com/viewarticle/
941446
Academia Letters, August 2021
©2021 by the author — Open Access — Distributed under CC BY 4.0
Corresponding Author: Carlo Bellieni, cvbellieni@gmail.com
Citation: Bellieni, C. (2021). Ethical drawbacks of treating doctors as heroes during the COVID pandemic.
Academia Letters, Article 2700. https://doi.org/10.20935/AL2700.
4
ACADEMIA Letters
Ethical drawbacks of treating doctors as heroes during the
COVID pandemic
Carlo Bellieni, Bioethics Committee of the University Hospital of Siena - Italy,
Bioethics Committee the Region of Tuscany - Italy
Medical doctors and nurses have serious reasons of worrying, and this wave of glorification as
heroes of the COVID pandemic, instead of helping them, risks of overshadowing their problems. Until a few months ago, the medical news on the media were full of reports showing
episodes of violence on the rise against doctors and nurses (1). The newspapers used to talk
of medicine in cases of edge-cutting breakthroughs of course, but mainly in cases of misconduct or medical errors. After the coronavirus outbreak, we only read of medical doctors as
healthcare heroes (2). This is the latest step of a negative path.
1. From demigods to employees
In the ancient past, doctors were something like “demigods” to the public: they knew how to
heal what was considered deadly, nefarious, and their actions were cloaked in mystery. Then,
the fall: in the last century the growth of technology and the fall of medical paternalism has
removed the aura of sacredness from medicine and the doctors have been normalized, but
with a worrying excess. They should be something more than mere dispensers of therapies
and drugs, but in pratics they are now employees and routine workers too often. And for them,
as for any other worker, the law of the market now applies.
Academia Letters, August 2021
©2021 by the author — Open Access — Distributed under CC BY 4.0
Corresponding Author: Carlo Bellieni, cvbellieni@gmail.com
Citation: Bellieni, C. (2021). Ethical drawbacks of treating doctors as heroes during the COVID pandemic.
Academia Letters, Article 2700. https://doi.org/10.20935/AL2700.
1
2. The corporatisation
Having reduced hospitals to companies (3) the budget becomes the main purpose and motivation, but what is included in the concept of a company is the concept of employee; and the
concept of employee conveys the idea of someone who does a repetitive job, prone to protocols, happy to be freed from worries because protocols propose the diagnostic and therapeutic
tools that make the risk of deciding superfluous, if applied as an acritical routine.
And above all, often doctors are not encouraged to do the extra mile off their duty, to
give an extra minute, to take care of the extra patient. This isn’t only the case for the work in
hospitals, but also for private practices, because in both cases the supreme rule of the doctorpatient relationship is the contract. The contract-based-medicine implies that you mustn’t do
anything less than what is written in the contract; but you should neither do anything more.
It’s a contract between an operator and a customer; once it was an alliance between a doctor
and a patient. But this generates dissatisfaction, and in the worst cases intolerance, complaints
and even physical violence if the contract doesn’t lead to the promised healing. Because the
contract promises recovery, or at least provides for it.
This is the nemesis, the revenge of the history that the Austrian philosopher Ivan Illich
described in his book “Medical Nemesis” (1976). He explained that medicine has been reduced to a series of protocols to apply to a series of determined situations, refusing a holistic
vision and preferring a medicine based on the cure of symptoms. Doctors have put too much
of their duty in the hands of lab results, and this has plugged their attention on the patient.
They thought to get more freedom, but they got more risks: no protocol and no test will guarantee the success, while most of medical activity is made of the time spent watching, talking,
examining, reflecting. This is one of the main causes of doctors’ dissatisfaction.
3. Everyday heroes
This routinary and disenchanted way of being doctors is common; the COVID pandemic has
pointed out that exceptions exist. But these exceptions are not limited to this episode. Warzones doctors have been heroes for centuries; as well as those doctors who everyday make
the extra mile to cure people at their own risk (4). But this kind of common heroism usually
benefits the poor people or poor countries and is therefore utterly neglected. Coronavirus, on
the converse, is also a high-income-countries disease, and for this reason has a preferential
track in vaccine making (who has ever seen that speed in vaccines for tuberculosis or zika of
malaria?). Are medical doctors being described as heroes in Western mass media, because
they’re treating a pathology that affects -among others - privileged countries?
Academia Letters, August 2021
©2021 by the author — Open Access — Distributed under CC BY 4.0
Corresponding Author: Carlo Bellieni, cvbellieni@gmail.com
Citation: Bellieni, C. (2021). Ethical drawbacks of treating doctors as heroes during the COVID pandemic.
Academia Letters, Article 2700. https://doi.org/10.20935/AL2700.
2
4. Reasons and risks of being treated as heroes
“Unfortunate is the country that needs heroes” Berthold Brecht wrote in his masterpiece “Life
of Galileo” (1938). Brecht did not want to make fun of the heroes, but pitied those who needed
them, because this need emerges when people live a lonely and routinary life. Three are the
main reasons for this sudden acknowledgement of doctors’ heroism. We have reminded above
that without the spread on rich countries of the COVID, all this interest in doctors’ activity
would not happen. Another reason is the general feeling of fear and loneliness expressed by
the population, that in similar times has always looked for a sort of supermen or superwomen
to save them. Moreover, the presence of superheroes is a fine opportunity for politics makers
to obtain two goals: misdirection and passage of responsibilities and duties (5).
An ethical approach to the phenomenon of medical glorification during the COVID pandemic needs to reckon doctors’ problems in everyday duties, and in particular in difficult
situations, difficult choices, hard relationships. An ethical approach should reckon that medical doctors risk to become employees, while they want more gratification and motivation; they
risk burnout, the rate of medical suicides is dramatically high. Medical COVID heroization
overshadows all this hard everyday scenario and draws health professionals as overaltruistic
and overstrong people, without specific and deep needs. Doctors and nurses are not happy for
this “heroization”, because this misdirects from the main focus: what doctors really want and
need. Otherwise, this will be nothing more than a soap bubble. Most doctors and nurses are
dissatisfied (6) and tired of uselessly asking for a better health system, many are disappointed;
in Italy, for instance, almost 3000 doctors a year abandon the public health system. (7) and
this problem of massive attrition is present in most countries (8). Being treated as heroes does
not change this scenario: we should ethically decide of redraw the image of medical doctors
on mass media and in public opinion, by pointing out how heroic but how tired most doctors
are.
Doctors’ glorification will soon disappear, but doctors’ problems won’t, as it overshadows
the real problems of this category. This glorification will be a soap bubble (9) if those who
want to be gratified by their work continue to be considered only “employees”, or engaged
with their patients not by trust but by contract. The healthcare system often does not give
motivation and respect, it is often based only on much bureaucracy, protocols and contracts..
True reasons to heal people in the most entusiastic way are needed; current routine and isolated
heroisations and can only get dissatisfaction.
Academia Letters, August 2021
©2021 by the author — Open Access — Distributed under CC BY 4.0
Corresponding Author: Carlo Bellieni, cvbellieni@gmail.com
Citation: Bellieni, C. (2021). Ethical drawbacks of treating doctors as heroes during the COVID pandemic.
Academia Letters, Article 2700. https://doi.org/10.20935/AL2700.
3
REFERENCES
1. Ahmed F, Khizar Memon M, Memon S. Violence against doctors, a serious concern for
healthcare organizations to ponder about. Ann Med Surg (Lond). 2017 Nov 15;25:3-5.
doi: 10.1016/j.amsu.2017.11.003. PMID: 29255603; PMCID: PMC5725205.
2. Bauchner H, Easley TJ; entire editorial and publishing staff of JAMA and the JAMA
Network. Health Care Heroes of the COVID-19 Pandemic. JAMA. 2020 May 26;323(20):2021.
doi: 10.1001/jama.2020.6197. PMID: 32310289.
3. Bellieni CV. Consumerism: a threat to health? J R Soc Med. 2018 Apr;111(4):112.
doi: 10.1177/0141076818763332. Epub 2018 Mar 1. PMID: 29493346; PMCID:
PMC5900838.
4. Branch J, Calero EK, Mann P, Jones LD, Erwin D, Wright JM, Said S. Where the heroes
are: testing in a war zone. MLO Med Lab Obs. 2008 Jul;40(7):30, 32-4, 36. PMID:
18717499.
5. Farjam M, Bianchi F, Squazzoni F, Bravo G. Dangerous liaisons: an online experiment on the role of scientific experts and politicians in ensuring public support for antiCOVID measures. R Soc Open Sci. 2021 Mar 10;8(3):201310. doi: 10.1098/rsos.201310.
PMID: 33959315; PMCID: PMC8074882.
6. Smith R. Why are doctors so unhappy? There are probably many causes, some of them
deep. BMJ. 2001 May 5;322(7294):1073-4. doi: 10.1136/bmj.322.7294.1073. PMID:
11337419; PMCID: PMC1120219.
7. Rivetti C et al: [Ospedali. “Oltre 3.000 medici nel 2019 li hanno abbandonati per
passare nel privato o sul territorio”. Lo studio dell’Anaao Assomed] Italian text. http://
www.quotidianosanita.it/studi-e-analisi/articolo.php?articolo_id=95447
8. Castro Lopes S, Guerra-Arias M, Buchan J, Pozo-Martin F, Nove A. A rapid review
of the rate of attrition from the health workforce. Hum Resour Health. 2017 Mar
1;15(1):21. doi: 10.1186/s12960-017-0195-2. PMID: 28249619; PMCID: PMC5333422.
9. Drummond D: Stop Calling Doctors Heroes and Saints: The Case Against Altruism.
Medscape Pediatrics November 2020 available at: https://www.medscape.com/viewarticle/
941446
Academia Letters, August 2021
©2021 by the author — Open Access — Distributed under CC BY 4.0
Corresponding Author: Carlo Bellieni, cvbellieni@gmail.com
Citation: Bellieni, C. (2021). Ethical drawbacks of treating doctors as heroes during the COVID pandemic.
Academia Letters, Article 2700. https://doi.org/10.20935/AL2700.
4
Carlo V Bellieni