Moral judgments about patients—who is considered "innocent" versus blamed for illness—shape sympathy, policy, and care. Kurt Blankschaen examines types of moral innocence, historical harms, and why simply removing the concept from medicine won’t be straightforward.
Public and provider sympathy often favors patients perceived as "innocent," producing disparities in attention and care even for clinically similar conditions.
Moral innocence appears in three forms in medicine: blame-free (who is seen as faultless), aspirational (an ideal of how people or systems might be), and developmental (expectations tied to stages of life).
Historical cases, notably early HIV/AIDS responses, show that invoking moral innocence can justify withholding care and fuel stigma toward marginalized groups.
Register for an account your email your username A password will be e-mailed to you. This type of sympathy shapes how people receive care, even if they have the same injury or illness as someone else. Consider, for example, the different levels of public sympathy between people with Type 1 and Type 2 diabetes.
Media narratives often portray people with Type 1 diabetes blameless because of their genetics or an autoimmune disorder, while people with Type 2 diabetes made bad choices about diet or not exercising. Given that RWHP has helped people who otherwise likely would have died live, and live longer, there has to be some viable place for moral innocence in medicine. Sometimes it happens because someone experiences evil or has to discard cherished beliefs.
Even when epidemiologists discovered that HIV could not be transmitted through casual contact, many hospitals and providers created obstacles for patients with HIV/AIDS with restrictive admissions, disingenuous referrals, or outright patient dumping. While many healthcare providers heroically rose to the occasion, others did not. I wasn't sure what to say, then, about the Ryan White HIV/AIDS Program (RWHP).
“Do No Harm” is perhaps the most famous medical maxim. But reciting it is one thing; living by it is another. Sometimes, the question of “harm” is up for debate. Throughout history, physicians have lent their knowledge to all manner of atrocities, warfare, torture, and mass sterilization, often justified under the supp
For those of us who have spent decades practicing medicine across multiple systems, the daily reality feels less like the noble healing art we trained for and more like a corporate assembly line. We watch as science-based, patient-centered care is nickel-and-dimed by administrators into mere metrics. In our exhaustion,
“I know the treatment probably won’t work,” a patient nearing the end of life tells the doctor. “I want to try anyway.” The patient understands the risks but still hopes for a little more time. The physician wants to honor that hope while worrying that side effects could make the patient’s remaining days more painful.
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In the 1985 book “ Habits of the Heart ,” Robert Bellah and his co-authors introduced “Sheilaism,” named for a woman they called Sheila Larson. Her individualized faith took the self as its highest authority: What felt right to her became the measure of what was right. Four decades later, Sheilaism has escaped the page
The practice of editing the genes of embryos remains highly controversial and risky, but Origin Genomics founder Cathy Tie argues its a “moral imperative” to address hereditary diseases.
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